Nephron-sparing approach to bilateral Wilms' tumor: in situ or ex vivo surgery and radiation therapy.
Bilateral Wilms' tumor patients, who experience local recurrence after maximal multimodality therapy, present a difficult surgical problem. The role of surgery in the management of these patients has changed from ablation to preservation of renal tissue, with bilateral nephrectomy as a last resort. Two children who had recurrent tumors in the remaining kidney underwent nephron-sparing surgery and focal intraoperative radiation therapy. In one case, this nephron-sparing surgery and intraoperative radiation therapy were performed in situ, in the other kidney was removed and reimplanted (ex vivo bench surgery and irradiation). These techniques may allow complete obliteration of gross and microscopic disease, while maximizing residual renal function.
Longaker
M T
MT
Department of Surgery, University of California, San Francisco 94143-0506.
Harrison
M R
MR
Adzick
N S
NS
Crombleholme
T M
TM
Langer
J C
JC
Duncan
B W
BW
Halberg
F E
FE
Salvatierra
O
O
D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy / Q000601:surgery; D009392:Nephrectomy; D011882:Radiotherapy, High-Energy / Q000379:methods; D012092:Replantation; D009396:Wilms Tumor / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*