Successful treatment of intracaval and atrial extension of Wilms’ tumour by chemotherapy

Berberoĝlu, Semha; Akyüz, Canan; Büyükpamukçu, Münevver

doi:10.1136/pgmj.72.854.749

Cited by 10 publications

(7 citation statements)

References 12 publications

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“…Note that 43 documented papers (Table S1) reported paediatric patients with Wilms tumour and intravascular extension, with age in the range of 7 weeks‐16 years. Sample size ranged from 1 to 165 patients.…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

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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“…Chemotherapy reduces the size of the tumour and offers the benefits of lower surgical morbidity and easy surgical removal [3,7,16,17]. Even complete dissolution of tumour thrombus is possible [5,18]. Complete intracardiac tumour regression post-chemotherapy allowed us to avoid the use CPB in two patients.…”

Section: Discussionmentioning

confidence: 99%

“…Since the introduction of chemotherapy and radiotherapy, in addition to total tumour nephrectomy, the overall survival rate of unilateral WT has improved to more than 90%. [1,[4][5][6]. Advances in surgical techniques and neoadjuvant chemotherapy have further improved the prognosis, by minimising the related surgical complications [7].…”

mentioning

confidence: 99%

Management of nine cases of Wilms’ tumour with intracardiac extension — a single centre experience

Abdullah

Karpelowsky

Davidson

et al. 2013

Journal of Pediatric Surgery

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“…18,19 In contrast, initial chemotherapy has been used extensively by members of the International Society of Pediatric Oncology. A decrease in the size of the intravascular extension has been reported by several authors as a result of preoperative therapy, albeit based on limited numbers of patients, [5][6][7][8][9][10][11][12][13][14][15][16][17] and it has been further suggested that preoperative therapy may decrease the risk of surgical complications. 3,4,11 The potential benefit of preoperative therapy must be balanced against the disadvantages, including loss of accurate staging information.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Prior reports have suggested that preoperative treatment of children with intravascular extension may be of benefit. [5][6][7][8][9][10][11][12][13][14][15][16][17] We reviewed the case histories of children treated on the most recent NWTS to define the incidence and manifestations of and optimal therapy for those with intravascular extension of Wilms tumor.…”

Section: Discussionmentioning

confidence: 99%

Intravascular Extension of Wilms Tumor

Shamberger¹,

Ritchey²,

Haase³

et al. 2001

Annals of Surgery

156

148

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ObjectiveTo define the incidence and manifestations of and optimal therapy for children with intravascular extension of Wilms tumor. MethodsChildren on a collaborative study of Wilms tumor who had intravascular extension into the inferior vena cava (IVC) or atrium were identified. Surgical checklists and surgical and pathology reports were reviewed. ResultsOne hundred sixty-five of 2,731 patients had intravascular extension of Wilms tumor. The level of extension was IVC in 134 and atrium in 31. Sixty-nine had received preoperative therapy (55 with IVC extension and 14 with atrial extension) for a median of 8 weeks. Complications during preoperative chemotherapy were seen in five patients (tumor embolism and tumor progression in one each, and three with adult respiratory distress syndrome, one of which was fatal). The intravascular extension of the tumor regressed in 39 of 49 children with comparable pre-and posttherapy radiographic studies, including 7 of 12 in whom the tumor regressed from an atrial location, thus obviating the need for cardiopulmonary bypass. Surgical complications occurred in 36.7% of the children in the atrial group and 17.2% in the IVC group. The frequency of surgical complications was 26% in the primary resection group versus 13.2% in children with preoperative therapy. When all the complications of therapy were considered, including those that occurred during the interval of preoperative chemotherapy (one of the five also had a surgical complication), the incidence of complications among those receiving preoperative therapy was not statistically different from the incidence among those who underwent primary resection. The difference in 3-year relapse-free survival (76.9% for 165 patients with intravascular extension, 80.3% for 1,622 patients with no extension) was not statistically significant whether or not it was adjusted for stage and histology.

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Successful treatment of intracaval and atrial extension of Wilms’ tumour by chemotherapy

Cited by 10 publications

References 12 publications

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

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

Management of nine cases of Wilms’ tumour with intracardiac extension — a single centre experience

Intravascular Extension of Wilms Tumor

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