A Single Center Experience With Bilateral Wilms Tumor

Area of Science:

• Pediatric Oncology
• Nephrology
• Surgical Oncology

Background:

• Wilms tumor (WT) is the most common pediatric kidney cancer.
• Bilateral Wilms tumor (BWT) affects 5% of cases and is linked to worse prognoses.
• Current BWT management lacks standardized treatment protocols.

Purpose of the Study:

• To evaluate treatment strategies and outcomes for bilateral Wilms tumor (BWT) at a single institution.
• To analyze the impact of pre-operative biopsy, chemotherapy, and surgical approach on BWT patient outcomes.
• To identify areas for improvement in BWT management to enhance patient survival and renal function preservation.

Main Methods:

• Retrospective chart review of pediatric patients with WT from 1998-2018.
• Identification of patients diagnosed with and treated for BWT.
• Comparison of treatment courses, including pre-operative biopsies, neoadjuvant chemotherapy, and surgical resection.
• Analysis of post-operative outcomes: dialysis, renal transplantation, disease recurrence, and overall survival.

Main Results:

• Nine children with BWT were identified among 120 WT cases.
• Treatment approaches, including pre-operative biopsy and neoadjuvant chemotherapy, varied significantly.
• Post-operatively, 44% of patients required dialysis, with 22% undergoing renal transplantation.
• Disease recurrence was observed in 71% of patients with available follow-up, and overall survival was 71%.

Conclusions:

• Management of bilateral Wilms tumor (BWT) demonstrates considerable variability in pre-operative interventions and surgical strategies.
• The observed high rates of recurrence and need for renal replacement therapy underscore the challenges in BWT treatment.
• Development of evidence-based guidelines for BWT management is crucial for optimizing outcomes in pediatric patients.