Prospective analysis of long-term renal function in survivors of childhood Wilms tumor

Neu, Marie A.; Russo, Alexandra; Wingerter, Arthur; Alt, Francesca; Theruvath, Johanna; Malki, Khalifa El; Kron, Bettina; Dittrich, Matthias; Lotz, Johannes; Stein, Raimund; Beetz, Rolf; Faber, Joerg

doi:10.1007/s00467-017-3673-9

Cited by 42 publications

(36 citation statements)

References 43 publications

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“…As per the UMBRELLA SIOP‐RTSG 2016 Wilms tumor protocol, nephron‐sparing surgery is acceptable in unilateral WT, providing at least 50% of renal tissue could be spared. In order to preserve as much renal tissue as possible and decrease renal and cardiac morbidity for long‐term survivors, nephron‐sparing surgery is always the preferred option 15,16 . MIS is appropriate only if the tumor has either a location (multiple small tumors, hilar tumor) or a volume that requires complete nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive surgery for unilateral Wilms tumors: Multicenter retrospective analysis of 50 transperitoneal laparoscopic total nephrectomies

Bouty

Blanc

Leclair

et al. 2020

Pediatric Blood & Cancer

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Purpose To evaluate feasibility and outcomes of minimally invasive surgery (MIS) in Wilms tumor (WT). Methods International multicenter review of MIS total nephrectomies for WT between 2006 and 2018. Medical records of confirmed WT were retrospectively assessed for demographic, imaging, treatment, pathology, and oncological outcome data. Results Fifty patients, with a median age of 38 months (6‐181), were included in 10 centers. All patients received neoadjuvant chemotherapy, as per SIOP protocol. Median tumor volume post‐chemotherapy was 673 mL (18‐3331), 16 tumors crossed the lateral border of the spine, and three crossed the midline. Six patients with tumors that crossed the lateral border of the spine (tumor volumes 1560 mL [299‐2480]) were converted to an open approach. There was no intraoperative tumor rupture. Overall, MIS was completed in 19% of the 195 nephrectomies for WT presenting during the study period. Tumor was stage I in 29, II in 16, and III in 5, and histology was reported as low in three, intermediate in 42, and high risk in five. Three patients had positive tumor margins. After a median follow‐up of 34 months (2‐138), there were two local recurrences (both stage I, intermediate risk, 7 and 9 months after surgery) and one metastatic relapse (stage III, high risk, four months after surgery). The three‐year event‐free survival was 94%. Conclusion MIS is feasible in 20% of WT, with oncological outcomes comparable with open surgery, no intraoperative rupture, and a low rate of local relapse. Ongoing surveillance is, however, needed to evaluate this technique as it becomes widespread.

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Section: Discussionmentioning

confidence: 99%

“…In order to preserve as much renal tissue as possible and decrease renal and cardiac morbidity for long-term survivors, nephron-sparing surgery is always the preferred option. 15,16 MIS is appropriate only if the tumor has either a location (multiple small tumors, hilar tumor) or a volume that requires complete nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery for unilateral Wilms tumors: Multicenter retrospective analysis of 50 transperitoneal laparoscopic total nephrectomies

Bouty

Blanc

Leclair

et al. 2020

Pediatric Blood & Cancer

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“…In an English study, Bailey reported compensatory renal hypertrophy in 38/40 patients [41]. Neu et al detected compensatory contralateral renal hypertrophy in 88, 3% of TWs [42]. The mean percent of expected renal length in the TWs group was 118%, while in the control group, the value of expected renal length was nearly 100%.…”

Section: Discussionmentioning

confidence: 99%

“…However, further studies are needed to determine whether the absence of one kidney is a marker for CKD development [49]. In the Neu TWs study, 21/34 (62%) TWs (mean age 28.7 years, mean follow-up 24.8 years) had CKD stages I-III, based on cystatin-related eGFR [42]. The reason for those differences was the method of GFR estimation.…”

Section: Discussionmentioning

confidence: 99%

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Sonographic Image of Solitary Kidney in Wilms Tumour Survivors

Kosiak

Stefanowicz

Adamkiewicz-Drożyńska

et al. 2018

Kidney Blood Press Res

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Background/Aims: This study presents an analysis of the sonographic and laboratory parameters of solitary kidney in Wilms tumour survivors (TWs) and compares these parameters with those of healthy individuals. Methods: Fifty-three TWs who completed treatment for Wilms tumour and 44 healthy individuals were enrolled. The study protocol consisted of completing a medical history, sonographic examination of the solitary kidney, estimation of glomerular filtration rate (eGFR) by the Schwartz or MDRD formulas, albumin urine excretion and BP measurement. Results: Sonographic signs of kidney damage were observed in 22 (41,5%) TWs. The most frequently detected abnormalities are hyperechoic rings around renal pyramids (28,3% TWs). Hypertrophy of the solitary kidney occurred in 71,7% of cases. The mean volume of the solitary kidney was 77% of the sum of the two kidney volumes in the control group. The median eGFR in the TWs group was 117 with 25Q-105,5, 75Q-130 ml/min/1,73 m² vs 131,8 with 25Q-124, 75Q-140 ml/min/1,73 m² in the control group (p=0,000). Six TWs (11,3%) had a value of eGFR below 90 ml/min/1,73 m². Increased urine albumin excretion (> 30 mg/g) was observed in 7 TWs (13,2%) and in 3 (6,8%) individuals in the control group. Conclusion: Ultrasonographic abnormalities in solitary kidney of TWs are frequent. The most frequently detected abnormalities are hyperechoic rings around renal pyramids. Sonographic examination of TWs ought to be performed not only to detect tumour recurrence but also to assess the signs of kidney damage and their progression.

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Kidney‐sparing whole abdominal irradiation in Wilms tumor: Potential advantages of VMAT technique

Chen

Leão

Simoes

et al. 2020

Pediatric Blood & Cancer

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Purpose To present a preliminary clinical experience and a dosimetric comparison of kidney‐sparing volumetric modulated arc therapy (VMAT) with three‐dimensional conformal radiotherapy (3D‐CRT) for whole abdominal irradiation (WAI), in the setting of Wilms tumor (WT) treatment. Materials and methods From a total of 20 consecutive WT cases treated with adjuvant irradiation, seven were submitted to WAI with VMAT. Renal function and survival rates were evaluated, and, for comparison purposes, similar VMAT and 3D‐CRT treatment plans were performed for WAI patients, and differences were dosimetrically evaluated regarding doses to the remaining kidney and other organs at risk and the planning target volume (PTV). Results After a median follow‐up time of 40.8 months (35.3‐52.2), no acute significant intestinal toxicity was observed, and median creatinine clearance was 110.1 and 103.3 mL/min/1.73 m², respectively, before treatment and at last follow‐up for WAI patients (P = 0.128). For comparative plans, maximum and median doses were lower for the remaining kidney with VMAT than with 3D‐CRT. VMAT was associated with better PTV coverage as compared with 3D‐CRT, with superior results for all the evaluated parameters (D95, D2, V100%, V98%, V95%; P = 0.018). Conclusion The use of VMAT technique is associated with lower radiation doses to the remaining kidney and better coverage to the PTV than 3D‐CRT technique for WAI, with preliminary clinical experience showing a favorable toxicity profile. Long‐term results from prospective studies might prove the ability of VMAT to spare renal function in the setting of WT treatment.

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Prospective analysis of long-term renal function in survivors of childhood Wilms tumor

Cited by 42 publications

References 43 publications

Minimally invasive surgery for unilateral Wilms tumors: Multicenter retrospective analysis of 50 transperitoneal laparoscopic total nephrectomies

Minimally invasive surgery for unilateral Wilms tumors: Multicenter retrospective analysis of 50 transperitoneal laparoscopic total nephrectomies

Sonographic Image of Solitary Kidney in Wilms Tumour Survivors

Kidney‐sparing whole abdominal irradiation in Wilms tumor: Potential advantages of VMAT technique

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