The value of surgery in directing therapy for patients with Wilms' tumor with pulmonary disease. A report from the National Wilms' Tumor Study Group (National Wilms' Tumor Study 5)

Ehrlich, Peter F.; Hamilton, Thomas E.; Grundy, Paul E.; Ritchey, Michael L.; Haase, Gerald M.; Shamberger, Robert C.

doi:10.1016/j.jpedsurg.2005.10.020

Cited by 73 publications

(28 citation statements)

References 19 publications

(51 reference statements)

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“…5 In this respect, it is important to note that in children with WT not all lesions detected on CT scan are necessarily metastatic in origin. 6 In our study, 1 child who underwent pulmonary resection for suspected metastatic disease and another for recurrent pulmonary disease, histologic diagnosis was erroneous (nonmalignant).…”

Section: Discussionmentioning

confidence: 68%

The Relationship Between the Site of Metastases and Outcome in Children With Stage IV Wilms Tumor

Berger

Fernández-Pineda

Cabello

et al. 2013

Journal of Pediatric Hematology/Oncology

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Summary:The aim of this study was to analyze in detail the site of metastasis of stage 4 Wilms tumor (WT) and its correlation with outcome. The databases from 3 major European pediatric cancer institutions were screened for children with WT between 1994 and 2011. Of 208 children identified, 31 (14.9%) had metastases at diagnosis. The lung was affected in 29 children (93.5%) and the liver in 6 children (19.4%). Twenty-seven children (87.1%) had metastases isolated to 1 organ, with the lung being the most common site (80.7%). Five-year overall survival was significantly better in those children with distant disease in either lung or liver (95.8%) compared with those affected in both lung and liver (57.1%, P = 0.028). Further, prognostic markers were the response of metastases to preoperative chemotherapy (P = 0.0138), high-risk histology (P = 0.024), and local stage (P = 0.026). Five-year overall survival was 82.1% and 5-year event-free survival was 67.9%. The overall follow-up time was 74.1 and 87.2 (2 to 151) months among survivors, and the treatment-related complication rate was 16.7%. In conclusion, in our series of stage 4 WT, prognosis was excellent if histology was favorable, metastatic disease was isolated to either lungs or liver, and if metastases responded to preoperative chemotherapy.Key Words: metastases, pediatric cancer, risk stratification, survival, Wilms tumor (J Pediatr Hematol Oncol 2013;35:518-524) W ilms tumor (WT) is the most common renal malignancy in childhood and the second most frequent intraabdominal pediatric cancer after neuroblastoma. 1 Many recent advances in clinical care and the biology of this tumor have pushed the overall survival (OS) to 90%. Naturally, for children with distant metastases the OS is lower. 1 Little is known on metastatic disease in stage 4 WT and its implication on therapy and outcome. 2,3 The lungs have long been recognized as a common site of distant tumor spread in stage 4 WT and several recent studies focus on this entity. 1,2 To our knowledge, no complete description of the metastatic profile of stage 4 WT at diagnosis exists at present. Therefore, in this study we reviewed children treated at 3 European pediatric cancer institutions for WT regarding their metastatic profile at diagnosis and its implication on long-term outcome. METHODS AND PATIENTS PatientsA retrospective analysis of the WT databases at the following 3 institutions was carried out: Hannover Medical School, Hannover (Germany); Dr. von Hauner Children's Hospital, Munich (Germany); and Virgen del Rocı´o Children's Hospital, Seville (Spain). Inclusion criteria were metastatic disease at diagnosis. Consequently, children with lower stage tumors who relapsed with metastatic disease were excluded. Additional exclusion criteria were other renal tumor entities like clear cell sarcoma, rhabdoid tumor, or renal cell carcinoma. TreatmentStaging criteria for WT was based on an upfront chemotherapy-based system developed by the International Society of Pediatric Oncology (SIOP). Treatment was accord...

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Section: Discussionmentioning

confidence: 68%

The Relationship Between the Site of Metastases and Outcome in Children With Stage IV Wilms Tumor

Berger

Fernández-Pineda

Cabello

et al. 2013

Journal of Pediatric Hematology/Oncology

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“…Patients had one (24), two (16), three (2), four or with a mean hospital stay of 5 days (2-9). Repeat thoracotomy in recurrent lung metastases was not associated with an increase in morbidity or an increase of chest tube drainage or hospital stay.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, CT imaging is unable to distinguish benign from malignant pulmonary disease or surgical scarring of the pulmonary parenchyma in patients who have had multiple thoracotomies, demonstrating the need for histopathological confirmation. In their series of patients with Wilms' tumor and pulmonary disease, Ehrlich et al [24] demonstrated that only 82% of patients with isolated pulmonary lesions and 69% with multiple lesions at CT scan had tumor proven on surgical biopsy. In this group 33% of patients with pulmonary lesions but with negative biopsy had unneeded pulmonary radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors and long-term results of pulmonary metastasectomy for pediatric histologies☆

Tronc

Conter

Marec‐Bérard

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…Previous studies of WT have assessed the correlation between nodules identified on CT with biopsy-proven metastases. One such study reported that single pulmonary nodules were more likely to be malignant (82%) than multiple nodules (69%) (10,11). Another study showed that the size of pulmonary nodules was not predictive for malignancy in pediatric patients with solid tumors, although only 4 of these patients had WT (12).…”

Section: Discussionmentioning

confidence: 99%

Influence of Pulmonary Nodules on Chest Computed Tomography and Risk of Recurrence in Stage IV Wilms Tumor

Kirkland

Nanda

Alazraki

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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The value of surgery in directing therapy for patients with Wilms' tumor with pulmonary disease. A report from the National Wilms' Tumor Study Group (National Wilms' Tumor Study 5)

Cited by 73 publications

References 19 publications

The Relationship Between the Site of Metastases and Outcome in Children With Stage IV Wilms Tumor

The Relationship Between the Site of Metastases and Outcome in Children With Stage IV Wilms Tumor

Prognostic factors and long-term results of pulmonary metastasectomy for pediatric histologies☆

Influence of Pulmonary Nodules on Chest Computed Tomography and Risk of Recurrence in Stage IV Wilms Tumor

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