Impact of lymph node evaluation in adjuvant and neoadjuvant chemotherapy settings on survival outcomes in Wilms tumour: a review of 185 cases from a single institution

Nanda, Ronica H.; Shehata, Bahig M.; Khoshnam, Nasim; Durham, Megan M.; Kim, Sungjin; Selwanes, Wasim; Zhang, Chao; Esiashvili, Natia

doi:10.1016/j.pathol.2016.09.062

Cited by 12 publications

(9 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite the improved staging accuracy and potential survival benefit associated with lymph node dissection in WT surgeries, patients are routinely under-sampled. In the series presented by Nanda et al ( 20 ), 75% of patients had fewer than seven nodes sampled and other trials have reported no lymph node sampling in 9% of patients ( 9 , 17 , 19 ). When lymph node dissection is performed, intraoperative discrimination between benign and malignant lymph nodes is relatively poor.…”

Section: Wtmentioning

confidence: 94%

“…For stage I patients who often do not receive adjuvant therapy, Shamberger et al determined that retroperitoneal nodal dissection also reduced the risk of recurrence ( 19 ). While there is no standard number of nodes to sample during WT surgeries, some studies have shown that increasing the number of nodes (many have used >7 nodes as a threshold value) improves detection of nodal involvement ( 18 , 20 ), although nodal positivity was shown to negatively impact survival ( 9 , 21 ).…”

Section: Wtmentioning

confidence: 99%

See 1 more Smart Citation

Lymph node imaging of pediatric renal and suprarenal malignancies

Gold

Sabarwal

Gordhan

et al. 2018

Transl. Androl. Urol

View full text Add to dashboard Cite

Pediatric renal and suprarenal cancers are relatively rare malignancies, but are not without significant consequence to both the patient and caretakers. These tumors are often found incidentally and present as large abdominal masses. Standard of care management involves surgical excision of the mass, but contemporary treatment guidelines advocate for use of neoadjuvant or adjuvant chemotherapy for advanced stage disease, such as those cases with lymph node involvement (LNI). However, LNI detection is based primarily on surgical pathology and performing extended lymph node dissection can add significant morbidity to a surgical case. In this review, we focus on the use and performance of imaging modalities to detect LNI in Wilms’ tumor (WT), neuroblastoma, and pediatric renal cell carcinoma (RCC). We report on how imaging impacts management of these cases and the clinical implications of LNI. A literature search was conducted for studies published on imaging-based detection of LNI in pediatric renal and suprarenal cancers. Further review focused on surgical and medical management of those cases with suspected LNI. Current imaging protocols assisting in diagnosis and staging of pediatric renal and suprarenal cancers are generally limited to abdominal ultrasound and cross-sectional imaging, mainly computed tomography (CT). Recent research has investigated the role of more advance modalities, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), in the management of these malignancies. Special consideration must be made for pediatric patients who are more vulnerable to ionizing radiation and have characteristic imaging features different from adult controls. Management of pediatric renal and suprarenal cancers is influenced by LNI, but the rarity of these conditions has limited the volume of clinical research regarding imaging-based staging. As such, standardized criteria for LNI on imaging are lacking. Nevertheless, advanced imaging modalities are being investigated and potentially represent more accurate and safer options.

show abstract

Section: Wtmentioning

confidence: 94%

Section: Wtmentioning

confidence: 99%

Lymph node imaging of pediatric renal and suprarenal malignancies

Gold

Sabarwal

Gordhan

et al. 2018

Transl. Androl. Urol

View full text Add to dashboard Cite

show abstract

“…S3). 30,[42][43][44][45][46][47] 10. The panel recommends sampling of lymph nodes at the time of resection of WT; pathologic assessment of lymph node histology before and after chemotherapy is feasible and of value in staging.…”

Section: Very Low Certaintymentioning

confidence: 99%

Evidence‐based surgical guidelines for treating children with Wilms tumor in low‐resource settings

Abdelhafeez

Reljic

Kumar

et al. 2022

Pediatric Blood & Cancer

Self Cite

View full text Add to dashboard Cite

Background Survival of Wilms tumor (WT) is > 90% in high‐resource settings but < 30% in low‐resource settings. Adapting a standardized surgical approach to WT is challenging in low‐resource settings, but a local control strategy is crucial to improving outcomes. Objective Provide resource‐sensitive recommendations for the surgical management of WT. Methods We performed a systematic review of PubMed and EMBASE through July 7, 2020, and used the GRADE approach to assess evidence and recommendations. Recommendations Initiation of treatment should be expedited, and surgery should be done in a high‐volume setting. Cross‐sectional imaging should be done to optimize preoperative planning. For patients with typical clinical features of WT, biopsy should not be done before chemotherapy, and neoadjuvant chemotherapy should precede surgical resection. Also, resection should include a large transperitoneal laparotomy, adequate lymph node sampling, and documentation of staging findings. For WT with tumor thrombus in the inferior vena cava, neoadjuvant chemotherapy should be given before en bloc resection of the tumor and thrombus and evaluation for viable tumor thrombus. For those with bilateral WT, neoadjuvant chemotherapy should be given for 6–12 weeks. Neither routine use of complex hilar control techniques during nephron‐sparing surgery nor nephron‐sparing resection for unilateral WT with a normal contralateral kidney is recommended. When indicated, postoperative radiotherapy should be administered within 14 days of surgery. Post‐chemotherapy pulmonary oligometastasis should be resected when feasible, if local protocols allow omission of whole‐lung irradiation in patients with nonanaplastic histology stage IV WT with pulmonary metastasis without evidence of extrapulmonary metastasis. Conclusion We provide evidence‐based recommendations for the surgical management of WT, considering the benefits/risks associated with limited‐resource settings.

show abstract

“…Adequately documented surgical staging should include lymph node sampling and documentation of local invasion, seeding or tumor spillage, and vascular extension (Supplemental Table S3). 28,[40][41][42][43][44][45] The panel recommends sampling of lymph nodes at the time of resection of WT; pathologic assessment of lymph node histology before and after chemotherapy is feasible and of value in staging. (Strong recommendation; Quality of evidence: Very Low) Panel deliberation.…”

Section: Operative Phasementioning

confidence: 99%

“…46 Lymph node sampling is an integral part of staging and should be completed at the time of tumor resection, regardless of whether neoadjuvant chemotherapy was given. 28,[40][41][42][43][44][45] At the time of sampling, five to seven lymph nodes should be obtained to reduce the risk of a false-negative finding. 41,44 The panel recommends neoadjuvant chemotherapy for the management of WT with inferior vena cava thrombus extension.…”

Section: Operative Phasementioning

confidence: 99%

Evidence-Based Surgical Guidelines for Treating Children with Wilms Tumor in Low-Resource Settings

Abdelhafeez

Reljic

Kumar

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Survival of Wilms tumor (WT) is >90% in high-resource settings but <30% in low-resource settings. Adapting a standardized surgical approach to WT is challenging in low-resource settings, but a local control strategy is crucial to improving outcomes. Objective: Provide resource-sensitive recommendations for the surgical management of WT. Methods: We performed a systematic review of PubMed and EMBASE through July 7, 2020, and used the GRADE approach to assess evidence and recommendations. Recommendations: Initiation of treatment should be expedited, and surgery should be done in a high-volume setting. Cross-sectional imaging should be done to optimize preoperative planning. For patients with typical clinical features of WT, biopsy should not be done before chemotherapy, and neoadjuvant chemotherapy should precede surgical resection. Also, resection should include a large transperitoneal laparotomy, adequate lymph node sampling, and documentation of staging findings. For WT with tumor thrombus in the inferior vena cava, neoadjuvant chemotherapy should be given before en bloc resection of the tumor and thrombus and evaluation for viable tumor thrombus. For those with bilateral WT, neoadjuvant chemotherapy should be given for 6–12 weeks. Neither routine use of complex hilar control techniques during nephron-sparing surgery, nor nephron-sparing resection for unilateral WT with a normal contralateral kidney is recommended. When indicated, postoperative radiotherapy should be administered within 14 days of surgery. Post-chemotherapy pulmonary oligometastasis should be resected when feasible, if local protocols allow omission of whole-lung irradiation in patients with non-anaplastic histology stage IV WT with pulmonary metastasis. Conclusion: We provide evidence-based recommendations for the surgical management of WT, considering the benefits/risks associated with limited-resource settings.

show abstract

Impact of lymph node evaluation in adjuvant and neoadjuvant chemotherapy settings on survival outcomes in Wilms tumour: a review of 185 cases from a single institution

Cited by 12 publications

References 13 publications

Lymph node imaging of pediatric renal and suprarenal malignancies

Lymph node imaging of pediatric renal and suprarenal malignancies

Evidence‐based surgical guidelines for treating children with Wilms tumor in low‐resource settings

Evidence-Based Surgical Guidelines for Treating Children with Wilms Tumor in Low-Resource Settings

Contact Info

Product

Resources

About