Wilms tumor: the problem of diagnostic accuracy in children undergoing preoperative chemotherapy without histological tumor verification.
From 1989 to 1992, 9 consecutive children with a tentative diagnosis of Wilms tumor underwent therapy planned according to the International Society of Pediatric Oncology (SIOP)-9 Wilms tumor protocol, including preoperative chemotherapy. Because tumor biopsy is not recommended in this SIOP-9 protocol due to a possible tumor spread from open or needle biopsy, diagnostic accuracy is mandatory. We present our problems in diagnostic accuracy resulting in withdrawal of 2 children from preoperative chemotherapy, understaging the tumor in 2 and missing exact tumor histology due to complete tumor necrosis in 2. In addition, preoperative chemotherapy was applied in 1 child who later was found to have renal cell carcinoma. Although the SIOP-9 protocol of Wilms tumor treatment may be effective with regard to reducing the intensity of therapy, staging problems may be a major drawback in this therapeutic strategy based on preoperative chemotherapy.
Zoeller
G
G
Department of Urology, Georg-August-University of Goettingen, Germany.
Pekrun
A
A
Lakomek
M
M
Ringert
R H
RH
D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D008297:Male; D011300:Preoperative Care; D009396:Wilms Tumor / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery