Mp55-02 Determining Radiologic Response to Neoadjuvant Chemotherapy for Wilms Tumor Prior to Partial Nephrectomy

You have accessJournal of UrologyPediatrics IV (MP55)1 May 2024MP55-02 DETERMINING RADIOLOGIC RESPONSE TO NEOADJUVANT CHEMOTHERAPY FOR WILMS TUMOR PRIOR TO PARTIAL NEPHRECTOMY Yash B. Shah, Sameer Mittal, Shriya Kakde, Dawud Hamdan, Susan Back, Christopher J. Long, and Thomas F. Kolon Yash B. ShahYash B. Shah , Sameer MittalSameer Mittal , Shriya KakdeShriya Kakde , Dawud HamdanDawud Hamdan , Susan BackSusan Back , Christopher J. LongChristopher J. Long , and Thomas F. KolonThomas F. Kolon View All Author Informationhttps://doi.org/10.1097/01.JU.0001008616.01808.0f.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Wilms tumor is the most common pediatric renal malignancy, yet optimal management remains unclear. Children's Oncology Group recommends upfront surgical resection except in cases of patients with cancer syndromes or bilateral disease, while Société Internationale d'Oncologie Pédiatrique favors routine neoadjuvant chemotherapy (NAC). Chemotherapeutics carry extensive toxicity, and determining the optimal duration of neoadjuvant treatment (6 vs 12 weeks) is difficult. We aimed to analyze the time-dependent effects of NAC on Wilms tumor radiologic response. METHODS: We performed an institutional retrospective review of patients receiving NAC for radiologically diagnosed Wilms tumor in syndromic or bilateral disease patients from 2006-2022. Variables of interest included demographics, presentation, chemotherapy type, and cancer syndrome. Radiologic data, aggregated from imaging at diagnosis, 6 weeks, and 12 weeks of NAC, and included tumor size, stage, and nodal involvement. Tumor volume was calculated using the prolate ellipsoid formula. Statistical analysis utilized Kruskal-Wallis and Wilcoxon rank-sum tests. RESULTS: In total, 28 patients were identified. 19 (67.9%) patients received a 12-week course of NAC, while 9 (32.1%) received surgery after 6 weeks. Demographics and oncologic data are presented in Table 1. Stage V disease was observed in 16 (57.1%) patients at diagnosis. Median tumor volume was 129.9cm3 on initial imaging, 26.1cm3 at 6 weeks, and 7.7cm3 at 12 weeks (p<0.001, Table 2). A greater than 20% reduction in tumor volume was seen in 24/27 (88.9%) patients from 0-6 weeks and 19/19 (100.0%) from 0-12 weeks. Median percent decrease in tumor volume was greater from 6-12 weeks than 0-6 weeks (90% vs 80%, p=0.041). CONCLUSIONS: Neoadjuvant chemotherapy offers significant cytoreduction in the majority of patients, and benefit may persist even beyond 6 weeks. With further study, guidelines may be adapted to recommend routine NAC, with treatment length modulated by comorbidities, disease severity, and pathology. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e916 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Yash B. Shah More articles by this author Sameer Mittal More articles by this author Shriya Kakde More articles by this author Dawud Hamdan More articles by this author Susan Back More articles by this author Christopher J. Long More articles by this author Thomas F. Kolon More articles by this author Expand All Advertisement PDF downloadLoading ...