Intracaval and intracardiac extension of Wilms' tumor: the influence of preoperative chemotherapy on surgical morbidity

Cristófani, Lílian Maria; Duarte, Ricardo; Almeida, Maria Tereza Assis de; Filho, Vicente Odone; Maksoud, João Gilberto; Srougi, Miguel

doi:10.1590/s1677-55382007000500010

Cited by 37 publications

(38 citation statements)

References 16 publications

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“…This strongly suggests that targeting transcription is a valuable anticancer approach. Moreover, additive combinations of actinomycin D with Vinca alkaloids were reported regarding their respective antiproliferative properties, suggesting the potential therapeutic benefit of combining this class of agents with triptolide (44). Furthermore, a recent publication showed that cytosine arabinoside sensitizes acute myeloid leukemia cells to low concentrations of triptolide (45).…”

Section: Discussionmentioning

confidence: 99%

Triptolide is an inhibitor of RNA polymerase I and II–dependent transcription leading predominantly to down-regulation of short-lived mRNA

Vispé

DeVries

Créancier

et al. 2009

Molecular Cancer Therapeutics

158

135

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Triptolide, a natural product extracted from the Chinese plant Tripterygium wilfordii, possesses antitumor properties. Despite numerous reports showing the proapoptotic capacity and the inhibition of NF-κB-mediated transcription by triptolide, the identity of its cellular target is still unknown. To clarify its mechanism of action, we further investigated the effect of triptolide on RNA synthesis in the human non-small cell lung cancer cell line A549. Triptolide inhibited both total RNA and mRNA de novo synthesis, with the primary action being on the latter pool. We used 44K human pan-genomic DNA microarrays and identified the genes primarily affected by a short treatment with triptolide. Among the modulated genes, up to 98% are down-regulated, encompassing a large array of oncogenes including transcription factors and cell cycle regulators. We next observed that triptolide induced a rapid depletion of RPB1, the RNA polymerase II main subunit that is considered a hallmark of a transcription elongation blockage. However, we also show that triptolide does not directly interact with the RNA polymerase II complex nor does it damage DNA. We thus conclude that triptolide is an original pharmacologic inhibitor of RNA polymerase activity, affecting indirectly the transcription machinery, leading to a rapid depletion of short-lived mRNA, including transcription factors, cell cycle regulators such as CDC25A, and the oncogenes MYC and Src. Overall, the data shed light on the effect of triptolide on transcription, along with its novel potential applications in cancers, including acute myeloid leukemia, which is in part driven by the aforementioned oncogenic factors. [Mol Cancer Ther 2009;8(10):2780-90]

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Section: Discussionmentioning

confidence: 99%

Triptolide is an inhibitor of RNA polymerase I and II–dependent transcription leading predominantly to down-regulation of short-lived mRNA

Vispé

DeVries

Créancier

et al. 2009

Molecular Cancer Therapeutics

158

135

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“…[7] In cases of Wilms tumor with cavo-atrial thrombus, the recommended surgical method is extraction of the primary renal and thrombus masses simultaneously in one session under cardiopulmonary bypass. [3][4][5][6][7] The overall prognosis of these patients with cavo-atrial thrombus is the same with the same histologic subtype without cavo-atrial thrombus. But as the surgical method is much more complicated, surgical morbidity and mortality is higher in patients with cavo-atrial thrombus.…”

Section: Discussionmentioning

confidence: 84%

“…In less than 1% of cases tumor thrombus may fill whole IVC and may extend into right side of the heart. [3,4] Abdullah et al reported that in 264 Wilms tumor patients 9 of them had cavo-atrial thrombus and 2 of them had right ventricular involvement. [5] In the report of Hadley et al in 10 of 406 (2.4%) Wilms tumor patients, extension of thrombus mass into the right atrium and ventricle was observed.…”

Section: Discussionmentioning

confidence: 99%

“…[1,2] In less than 10% of cases, as an extension of tumor tissue, tumor thrombus can be seen at the level of hepatic vein and inferior vena cava (IVC). [3] But extension of thrombus into whole IVC, right atrium and right ventricule (cavo-atrial thrombus) is observed in less than 1% of patients. [1,3] Since radiographic evaluations are very diagnostic and incisional or tru-cut biopsy can cause seeding metastases, in cases without distant metastases or that did not invade renal sinus, the primary method of treatment is surgery.…”

Section: Introductionmentioning

confidence: 99%

“…[3] But extension of thrombus into whole IVC, right atrium and right ventricule (cavo-atrial thrombus) is observed in less than 1% of patients. [1,3] Since radiographic evaluations are very diagnostic and incisional or tru-cut biopsy can cause seeding metastases, in cases without distant metastases or that did not invade renal sinus, the primary method of treatment is surgery. [1] If tumor thrombus is detected above the level of hepatic vein at the time of diagnosis, to achieve regression, the use of neoadjuvant chemotherapy for at least 5 weeks is recommended.…”

Section: Introductionmentioning

confidence: 99%

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A case of Wilms tumor with right ventricular extension of tumor thrombus

Çakan

Tokuç

Cerit

et al. 2017

CRIM

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Primary renal tumors comprise 6% of all childhood cancers. Wilms tumor is the most common primary renal tumor in pediatric age group and the peak age of diagnosis is 3-4 years. In 10% of cases tumor extension into hepatic vein and inferior vena cava can be seen. But tumor extension into whole inferior vena cava, right atrium and right ventricle is only seen in less than 1% of patients. A 2-year-old girl was admitted to the hospital because of abdominal distension that was noticed by the parents two weeks ago. Imaging studies revealed that she had a mass at the right renal lodge which was favoring to Wilms tumor and on thorax tomography tumor thrombus was seen in the whole inferior vena cava, right atrium and right ventricle. Neoadjuvant chemotherapy was given for 7 weeks. On the 8th week of diagnosis, under cardiopulmonary bypass, surgical operation by pediatric and cardiovascular surgery teams for primary renal tumor and for cavo-atrial tumor thrombus was performed. Pathological examination of the mass was reported as stage 3 diffuse anaplastic Wilms tumor. The patient completed 24 weeks of chemotherapy protocol and she is being followed for 15 months without any morbidity. We present our case to emphasize the importance of multidisciplinary approach in Wilms tumor with cardiac extension.

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Optimal neoadjuvant chemotherapy duration in Wilms tumour with intravascular thrombus: A literature review and evidence from SIOP WT 2001 trial

Morris

Squire

Sznajder

et al. 2019

Pediatric Blood & Cancer

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Introduction:Preoperative chemotherapy is recommended for children with Wilms tumour with intravascular extension. Extended chemotherapy may improve resectability, but increase tumour adherence to vascular endothelium, precluding complete resection. To evaluate the optimal length of preoperative treatment, we report a two-part review comprising systematic review of the literature and investigation of patients treated in the International Society of Paediatric Oncology (SIOP) WT 2001 trial. Methods: Studies were identified using Medline and Embase databases from 1996 to present. English language titles reporting management of intravascular Wilms tumour were analysed. Patients with Wilms tumour and thrombus were identified from the SIOP WT 2001 trial. Overall survival (OS) and event-free survival (EFS), tumour regression, completeness of resection and cavectomy were investigated. Results: The search retrieved 43 articles documenting 498 children. Note that 72% of the patients received neoadjuvant chemotherapy: 101 received standard course (4-6 weeks, standard course neoadjuvant chemotherapy [StC]) and 62 extended course (> 6 weeks, extended course neoadjuvant chemotherapy [EC]). There was no significant difference between the groups in terms of thrombus regression or completeness of resection. EFS was greater in the StC group (78 vs 54%; P = .04). Of 4511 patients registered in the SIOP WT 2001 trial, 166 had thrombus. Note that 97% of the patients received neoadjuvant chemotherapy: 63 StC and 67 EC. There was no significant difference between the groups with regard to tumour regression, complete resection, or cavectomy. Survival was significantly higher in those receiving StC than EC (OS: 95% vs 82%, P = .025; EFS: 88% vs 72%, P = .047). Conclusion:There is no evidence that prolonged courses of neoadjuvant chemotherapy beyond the recommended protocols confer any additional benefit in treating intravascular extension of Wilms tumour.

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Intracaval and intracardiac extension of Wilms' tumor: the influence of preoperative chemotherapy on surgical morbidity

Cited by 37 publications

References 16 publications

Triptolide is an inhibitor of RNA polymerase I and II–dependent transcription leading predominantly to down-regulation of short-lived mRNA

Triptolide is an inhibitor of RNA polymerase I and II–dependent transcription leading predominantly to down-regulation of short-lived mRNA

A case of Wilms tumor with right ventricular extension of tumor thrombus

Optimal neoadjuvant chemotherapy duration in Wilms tumour with intravascular thrombus: A literature review and evidence from SIOP WT 2001 trial

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