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Local control in synchronous bilateral Wilms tumor

A C Paulino1, J Wilimas, N Marina

  • 1Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.

International Journal of Radiation Oncology, Biology, Physics
|October 1, 1996
PubMed
Summary

Radiation therapy (RT) and chemotherapy (CT) combined with surgery offer excellent local control for synchronous bilateral Wilms Tumor (WT). Three-drug chemotherapy with RT significantly improves outcomes, demonstrating that renal conservation is viable for treating this condition.

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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).

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  • 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.