Agreement between clinicoradiological signs at diagnosis and radiohistological analysis after neoadjuvant chemotherapy of suspected Wilms tumor rupture: Consequences on therapeutic choices

Abstract

Introduction According to SIOP criteria, every patient presenting with preoperative Wilms tumor (WT) rupture must receive abdominal radiotherapy. Neoadjuvant chemotherapy reduces tumor volume and is responsible for the development of peritumoral capsule formation, which can mask tumor rupture on histological analysis, while it was clinically or radiologically obvious at diagnosis. Yet, there are no protocol recommendations for this particular presentation. Objectives Study the agreement between clinicoradiological signs and histological confirmation after neoadjuvant chemotherapy of suspected WT rupture and describe the therapeutic choices arising in consequence. Methods Descriptive retrospective study on a monocentric series of patients with WT between June 1991 and August 2017. Results Out of 71 patients, 28 presented with suspected tumor rupture. We observed good agreement between clinical and radiological signs of suspected rupture (κ coefficient: 0.67). However, we assessed poor agreement between these signs and histological conclusions after neoadjuvant chemotherapy (κ coefficient: 0.27). Only five patients with clinicoradiological signs were overtreated with radiotherapy while tumor rupture had been refuted after histological review. The notion of abdominal trauma and the presence of intraperitoneal effusion seemed to guide collegial decision to overtreat these patients. No statistical difference in survival between patients with and without suspicion of tumor rupture at diagnosis was observed. Conclusion This study highlights the need for recommendations in case of discrepancy between radiological and histological signs of rupture at diagnosis and after neoadjuvant chemotherapy. A study with stronger statistical power is necessary to define criteria that would lead to optimization of treatment in this context.

RNA-Sequencing, Connectivity Mapping, and Molecular Docking to Investigate Ligand-Protein Binding for Potential Drug Candidates for the Treatment of Wilms Tumor

“…The current treatment for children with Wilms tumor includes chemotherapy, which is given before or after surgery. Despite the increased cure rate for Wilms tumor following multimodal therapy, the recurrence rate remained relatively high (15%) for patients with low-grade Wilms tumor, and the five-year survival rate remains poor [23][24][25][26]. Therefore, an increasing number of studies have included the search for drugs to target the relevant genes in Wilms tumor, and have included salidroside and curcumin [27,28].…”

The role of imaging in the initial investigation of paediatric renal tumours

“…Extra-capsular rupture is important to recognise on imaging but does not always imply a change in the tumour stage 32 .…”

Duplex kidney complicated with preoperative inferior nephroblastoma rupture in children: a case report and literature review

“…Two cases of WT combined with duplex kidney have been reported in the literature in the last decade [3,4], which combined with our case makes a total of three cases reporting this condition. A total of 69 cases of WT combined with rupture have been reported in the literature [5,6]; thus, we analyzed a total of 70 cases (69 plus our case), which are presented below.…”