Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1994 Nov;220(5):683–690. doi: 10.1097/00000658-199411000-00013

Management and outcome of inoperable Wilms tumor. A report of National Wilms Tumor Study-3.

M L Ritchey 1, K C Pringle 1, N E Breslow 1, J Takashima 1, J Moksness 1, C W Zuppan 1, J B Beckwith 1, P R Thomas 1, P P Kelalis 1
PMCID: PMC1234458  PMID: 7979618

Abstract

METHODS: The authors reviewed 131 children enrolled in National Wilms Tumor Study-3 (NWTS-3) who received preoperative treatment for tumors unable to be resected at surgery or judged inoperable by imaging evaluation. Preoperative biopsies were performed on 103 patients. Patients were assigned a pretreatment stage: stage II (11 patients), stage III (39 patients), stage IV (66 patients), and unknown (15 patients). The chemotherapy regimen included dactinomycin and vincristine (81 patients), dactinomycin, vincristine, and doxorubicin (30 patients), dactinomycin, vincristine, doxorubicin, and cyclophosphamide (10 patients), and other (8 patients). Preoperative radiation therapy was started concurrently with chemotherapy (27 patients) or because of lack of response (14 patients). Two patients were given preoperative irradiation without chemotherapy. RESULTS: Response to therapy was assessed after the first trial of chemotherapy. Partial responses were noted in 110 patients (85%), 3 had complete responses, 13 had no response or progression of disease, and 5 patients were not able to be evaluated. There were no significant differences in preoperative response to the different chemotherapy regimens. Median time interval from diagnosis to nephrectomy was 58.5 days. When compared with NWTS-3 patients not receiving preoperative treatment, survival was reduced for patients treated preoperatively (88% vs. 74%, respectively, 4-year survival), which was only partially explained by differences in stage distribution. Median duration of follow-up was 5.9 years. Lack of response to the preoperative treatment was associated with a poor prognosis. Eight children died before removal of the primary tumor. All eight had either progressive disease or no response to the preoperative treatment. CONCLUSIONS: The use of preoperative treatment can facilitate subsequent surgical resection in selected patients with inoperable Wilms tumors. Although these very large tumors--judged unable to be resected--have a somewhat worse prognosis, nephrectomy was completed in 93% of patients after preoperative treatment. However, preoperative treatment will lead to less accurate surgical and pathologic staging, and undertreatment should be avoided in these high-risk patients.

Full text

PDF
687

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bracken R. B., Sutow W. W., Jaffe N., Ayala A., Guarda L. Preoperative chemotherapy for Wilms tumor. Urology. 1982 Jan;19(1):55–60. doi: 10.1016/0090-4295(82)90047-4. [DOI] [PubMed] [Google Scholar]
  2. Bürger D., Moorman-Voestermans C. G., Mildenberger H., Lemerle J., Voûte P. A., Tournade M. F., Rodary C., Delemarre J. F., Sandstedt B., Sarrazin D. The advantages of preoperative therapy in Wilms' tumour. A summarised report on clinical trials conducted by the International Society of Paediatric Oncology (SIOP). Z Kinderchir. 1985 Jun;40(3):170–175. doi: 10.1055/s-2008-1059738. [DOI] [PubMed] [Google Scholar]
  3. D'Angio G. J., Breslow N., Beckwith J. B., Evans A., Baum H., deLorimier A., Fernbach D., Hrabovsky E., Jones B., Kelalis P. Treatment of Wilms' tumor. Results of the Third National Wilms' Tumor Study. Cancer. 1989 Jul 15;64(2):349–360. doi: 10.1002/1097-0142(19890715)64:2<349::aid-cncr2820640202>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  4. D'Angio G. J., Rosenberg H., Sharples K., Kelalis P., Breslow N., Green D. M. Position paper: imaging methods for primary renal tumors of childhood: costs versus benefits. Med Pediatr Oncol. 1993;21(3):205–212. doi: 10.1002/mpo.2950210310. [DOI] [PubMed] [Google Scholar]
  5. Dykes E. H., Marwaha R. K., Dicks-Mireaux C., Sams V., Risdon R. A., Duffy P. G., Ransley P. G., Pritchard J. Risks and benefits of percutaneous biopsy and primary chemotherapy in advanced Wilms' tumour. J Pediatr Surg. 1991 May;26(5):610–612. doi: 10.1016/0022-3468(91)90719-a. [DOI] [PubMed] [Google Scholar]
  6. Evans A. E., Norkool P., Evans I., Breslow N., D'Angio G. J. Late effects of treatment for Wilms' tumor. A report from the National Wilms' Tumor Study Group. Cancer. 1991 Jan 15;67(2):331–336. doi: 10.1002/1097-0142(19910115)67:2<331::aid-cncr2820670202>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  7. Farewell V. T., D'Angio G. J., Breslow N., Norkool P. Retrospective validation of a new staging system for Wilms' tumor. Cancer Clin Trials. 1981;4(2):167–171. [PubMed] [Google Scholar]
  8. Green D. M., Breslow N. E., D'Angio G. J. The treatment of children with unilateral Wilms' tumor. J Clin Oncol. 1993 Jun;11(6):1009–1010. doi: 10.1200/JCO.1993.11.6.1009. [DOI] [PubMed] [Google Scholar]
  9. Lemerle J., Voute P. A., Tournade M. F., Rodary C., Delemarre J. F., Sarrazin D., Burgers J. M., Sandstedt B., Mildenberger H., Carli M. Effectiveness of preoperative chemotherapy in Wilms' tumor: results of an International Society of Paediatric Oncology (SIOP) clinical trial. J Clin Oncol. 1983 Oct;1(10):604–609. doi: 10.1200/JCO.1983.1.10.604. [DOI] [PubMed] [Google Scholar]
  10. Montgomery B. T., Kelalis P. P., Blute M. L., Bergstralh E. J., Beckwith J. B., Norkool P., Green D. M., D'Angio G. J. Extended followup of bilateral Wilms tumor: results of the National Wilms Tumor Study. J Urol. 1991 Aug;146(2 ):514–518. doi: 10.1016/s0022-5347(17)37840-0. [DOI] [PubMed] [Google Scholar]
  11. Ng Y. Y., Hall-Craggs M. A., Dicks-Mireaux C., Pritchard J. Wilms' tumour: pre- and post-chemotherapy CT appearances. Clin Radiol. 1991 Apr;43(4):255–259. doi: 10.1016/s0009-9260(05)80250-8. [DOI] [PubMed] [Google Scholar]
  12. Papers presented at the 20th annual meeting of the American Pediatric Surgical Association. Baltimore, Maryland, May 28-31, 1989. Proceedings. Part I. J Pediatr Surg. 1990 Jan;25(1):1–178. [PubMed] [Google Scholar]
  13. Ritchey M. L., Kelalis P. P., Breslow N., Etzioni R., Evans I., Haase G. M., D'Angio G. J. Surgical complications after nephrectomy for Wilms' tumor. Surg Gynecol Obstet. 1992 Dec;175(6):507–514. [PubMed] [Google Scholar]
  14. Ritchey M. L., Kelalis P. P., Haase G. M., Shochat S. J., Green D. M., D'Angio G. Preoperative therapy for intracaval and atrial extension of Wilms tumor. Cancer. 1993 Jun 15;71(12):4104–4110. doi: 10.1002/1097-0142(19930615)71:12<4104::aid-cncr2820711249>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  15. Sullivan M. P., Sutow W. W., Cangir A., Taylor G. Vincristine sulfate in management of Wilms' tumor. Replacement of preoperative irradiation by chemotherapy. JAMA. 1967 Oct 30;202(5):381–384. [PubMed] [Google Scholar]
  16. Thomas P. R., Shochat S. J., Norkool P., Beckwith J. B., Breslow N. E., D'Angio G. J. Prognostic implications of hepatic adhesion, invasion, and metastases at diagnosis of Wilms' tumor. The National Wilms' Tumor Study Group. Cancer. 1991 Dec 1;68(11):2486–2488. doi: 10.1002/1097-0142(19911201)68:11<2486::aid-cncr2820681128>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  17. Tournade M. F., Com-Nougué C., Voûte P. A., Lemerle J., de Kraker J., Delemarre J. F., Burgers M., Habrand J. L., Moorman C. G., Bürger D. Results of the Sixth International Society of Pediatric Oncology Wilms' Tumor Trial and Study: a risk-adapted therapeutic approach in Wilms' tumor. J Clin Oncol. 1993 Jun;11(6):1014–1023. doi: 10.1200/JCO.1993.11.6.1014. [DOI] [PubMed] [Google Scholar]
  18. Wagget J., Koop C. E. Wilms' tumor: preoperative radiotherapy and chemotherapy in the management of massive tumors. Cancer. 1970 Aug;26(2):338–340. doi: 10.1002/1097-0142(197008)26:2<338::aid-cncr2820260215>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  19. Zuppan C. W., Beckwith J. B., Weeks D. A., Luckey D. W., Pringle K. C. The effect of preoperative therapy on the histologic features of Wilms' tumor. An analysis of cases from the Third National Wilms' Tumor Study. Cancer. 1991 Jul 15;68(2):385–394. doi: 10.1002/1097-0142(19910715)68:2<385::aid-cncr2820680229>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES