Local control in synchronous bilateral Wilms tumor

Area of Science:

• Pediatric Oncology
• Radiation Oncology
• Surgical Oncology

Background:

• Synchronous bilateral Wilms Tumor (WT) presents unique challenges for local control.
• Multimodality treatment including surgery, chemotherapy (CT), and radiation therapy (RT) is often employed.
• Evaluating the specific roles of each modality is crucial for optimizing treatment strategies.

Purpose of the Study:

• To assess the effectiveness of radiation therapy (RT), chemotherapy (CT), and surgery in achieving local control for synchronous bilateral Wilms Tumor (WT).

Main Methods:

• A retrospective review of 38 children with synchronous bilateral WT treated between 1962 and 1993.
• Analysis of initial surgical approaches (nephrectomy, partial nephrectomy, biopsy) and chemotherapy regimens (two-drug vs. three-drug CT).
• Evaluation of radiation therapy (RT) application to kidneys and/or renal beds and subsequent local control rates.

Main Results:

• Overall local control was achieved in 87% of sites (66/76).
• Radiation therapy (RT) combined with three-drug chemotherapy demonstrated excellent local control, particularly in advanced stages.
• While two-drug chemotherapy was associated with a higher risk of loco-regional relapse compared to three-drug regimens (p = 0.004).

Conclusions:

• Renal-sparing surgical approaches can be utilized without compromising local control in bilateral Wilms Tumor (WT).
• The combination of radiation therapy (RT) and three-drug chemotherapy offers superior local control for synchronous bilateral Wilms Tumor (WT).
• Multimodality therapy, while effective, carries risks such as renal failure and bowel obstruction.