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Preoperative therapy for intracaval and atrial extension of Wilms tumor
M L Ritchey1, P P Kelalis, G M Haase
1Section of Urology, University of Michigan, Ann Arbor.
Insights
Preoperative therapy can safely manage Wilms tumor with intravascular extension, reducing tumor size and facilitating surgery. This approach improves outcomes for patients with extensive tumor involvement.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
Background:
- Wilms tumor with intravascular extension poses surgical challenges and risks.
- Primary surgical management often leads to significant patient morbidity.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of preoperative therapy for Wilms tumor with intravascular extension.
- To assess the impact of neoadjuvant treatment on surgical management and patient outcomes.
Main Methods:
- Retrospective analysis of 30 children with Wilms tumor and caval or atrial extension.
- Patients received neoadjuvant chemotherapy for an average of 7.2 weeks.
- Disease staging included Stage III (7), Stage IV (18), and Stage V (5) disease.
Main Results:
- Tumor size reduction was observed in 23 patients, with no instances of tumor embolization.
- Complete resolution of tumor thrombus occurred in seven patients.
- Two-year survival rate for the cohort was 70%.
Conclusions:
- Preoperative therapy is a suitable approach for selected Wilms tumor patients with extensive intravascular involvement.
- Neoadjuvant treatment simplifies surgical intervention by reducing primary tumor and thrombus size.
- This strategy enhances the feasibility of surgical management in complex cases.
Background:
Primary surgical management of Wilms tumor with intravascular tumor extension is associated with significant morbidity. Retrospective analysis of a group of Wilms tumor patients with intravascular tumor extension treated with preoperative therapy was performed to evaluate the feasibility of this approach.
Methods:
Thirty children with caval (15 patients) or atrial (15 patients) extension of Wilms tumor who received preoperative therapy were reviewed. Patients were classified according to the stage of the disease as follows: (1) Stage III, 7 patients; (2) Stage IV, 18 patients; and (3) Stage V, 5 patients. The histologic type was favorable in 20 patients, anaplastic Wilms tumor in 7, and unknown in 3. All of the children received preoperative chemotherapy, ranging from 1-16 weeks with an average of 7.2 weeks.
Results:
One child died of progressive disease and another from toxicity before surgery. In 23 patients, a decrease in the size of the intravascular extension was noted preoperatively, without tumor embolization in any case. There was complete resolution of tumor thrombus in seven patients. Two-year survival for the entire group is 70%, with a median follow-up period of 21 months.
Conclusions:
The use of preoperative therapy is appropriate in selected patients with extensive intravascular tumor involvement. Surgical management was facilitated in the majority of cases due to shrinkage of the primary tumor and reduction in the size of the tumor thrombus.
