Strategy for management of retroperitoneal tumors with caval tumor thrombus

Khozeimeh, Nini; Sinha, Pranava; Dome, Jeffrey S.; Guzzetta, Philip C.

doi:10.1016/j.jpedsurg.2011.06.041

Cited by 23 publications

(20 citation statements)

References 19 publications

(29 reference statements)

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“…Surgical complications in patients with intravascular tumor extension treated with initial surgery were as high as 43 % in NWTS-3, which decreased to 26 % in NWTS-4 [2,8]. These include massive hemorrhage which was the most common followed by tumor embolisation with acute cardiac decompensation or arrest.…”

Section: Discussionmentioning

confidence: 99%

“…This recommendation was based on the observation that most patients experience shrinkage of the tumor thrombus in response to chemotherapy. In some cases, shrinkage can avoid cardiopulmonary bypass (CPB) [2,8].…”

Section: Discussionmentioning

confidence: 99%

“…Neoadjuvant chemotherapy lowered the complication rate to 13.2 %. (P=0.053) [2,5,8]. In the UKW3 trial, preoperative chemotherapy was used in 52 of 59 patients with intracaval extension.…”

Section: Discussionmentioning

confidence: 99%

“…Significant shrinkage of the thrombus and tumor was demonstrated in the majority and avoided the need for cavotomy at the time of delayed nephrectomy in nearly 50 % of patients. However, this approach also has risks which include complications before surgery including pulmonary embolism, tumor progression, febrile neutropenia, acute respiratory distress syndrome, which may be fatal [2,5,8].…”

Section: Discussionmentioning

confidence: 99%

“…However it may rarely extend into the right atrium (1.4 %) [1]. The management of tumors that extend into the inferior vena cava is determined by extent of tumor thrombus, possibility of tumor embolus, histology type, responsiveness of the tumor to chemotherapy, and tumor stage at presentation [1,2]. However, neoadjuvant chemotherapy followed by surgery is advocated in tumor with intravascular extension [1,3].…”

Section: Introductionmentioning

confidence: 99%

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Nonresponsiveness to Chemotherapy: A Formidable Surgical Challenge in Wilms’ Tumor with Intracardiac Extension

Parelkar

Mundada

Oak

et al. 2013

Indian J Surg Oncol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Neoadjuvant chemotherapy lowered the complication rate to 13.2 %. (P=0.053) [2,5,8]. In the UKW3 trial, preoperative chemotherapy was used in 52 of 59 patients with intracaval extension.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Nonresponsiveness to Chemotherapy: A Formidable Surgical Challenge in Wilms’ Tumor with Intracardiac Extension

Parelkar

Mundada

Oak

et al. 2013

Indian J Surg Oncol

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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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