Key result
Preoperative chemotherapy for Wilms' tumor with cavoatrial extension resulted in 91% long-term survival compared to 100% with initial surgery, while reducing thrombus extension in 73% of patients.
Why the study?
Does preoperative chemotherapy improve surgical morbidity and long-term survival in children with Wilms' tumor and cavoatrial extension compared to initial surgery?
Cohort (n=16)
Does preoperative chemotherapy improve surgical morbidity and long-term survival in children with Wilms' tumor and cavoatrial extension compared to initial surgery?
Preoperative chemotherapy in children with Wilms' tumor and cavoatrial extension can reduce thrombus size and the need for cardiopulmonary bypass without compromising long-term survival.
Answers are grounded in this paper and cite their sources.
May support preoperative chemotherapy to reduce thrombus and bypass needs in Wilms' tumor; hypothesis-generating for survival equivalence without randomized data.
OBJECTIVES: The aim of this retrospective study is to compare surgical complications and long-term survival in children with Wilms' tumor (WT) and tumor thrombus receiving or not preoperative chemotherapy. MATERIALS AND METHODS: Review of the charts of 155 children with WT treated between 1983 and 2005, and analysis of 16/155 (10.3%) children with WT who presented cavoatrial tumor extension, being 8/16 IVC and 8/16 atrial thrombus. RESULTS: Median age was 54 months. 2/16 had cardiac failure as the first symptom. 11/16(7 IVC and 4 atrial extension) (67%) were submitted to preoperative chemotherapy with vincristine plus actinomycin D, and 5/16(1 IVC and 4 atrial) (33%) underwent initial nephrectomy and thrombus resection. So, 11 patients were submitted to preoperative VCR/ACTD and 2/11 (18.1%) had complete regression of the thrombus, 6/11(54.5%) partial regression and 3/11 (27%) had no response. Among the partial responders, nephrectomy with thrombus removal was performed in all, including one patient with previous intracardiac involvement, without extracorporeal circulation procedures. In two of the three non-responders, cardiopulmonary bypass was necessary for thrombus removal. There were no surgical related deaths. Long-term survival is 91% in the group submitted to preoperative chemotherapy and 100% in the group who had surgery as first approach. CONCLUSION: Preoperative chemotherapy was able to reduce thrombus extension in 8/11 (73%) treated patients and cardiopulmonary bypass was avoided in 2 patients with atrial thrombus. Surgical resection of tumor and thrombus was successful in all cases, receiving or not preoperative chemotherapy and overall survival was similar in both groups.
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Cristófani et al. (2007) conducted a cohort in Wilms' tumor with cavoatrial tumor extension (n=16). Preoperative chemotherapy (vincristine plus actinomycin D) vs. Initial nephrectomy and thrombus resection (no preoperative chemotherapy) was evaluated on Long-term survival. Preoperative chemotherapy for Wilms' tumor with cavoatrial extension resulted in 91% long-term survival compared to 100% with initial surgery, while reducing thrombus extension in 73% of patients.
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