title: Local control in synchronous bilateral Wilms tumor.
abstract: OBJECTIVE
  To evaluate the role of radiation therapy (RT), chemotherapy (CT), and surgery in the local control of synchronous bilateral Wilms Tumor (WT).
  
  
  METHODS
  Between 1962 to 1993, 45 children were treated for bilateral WT; 38 patients with synchronous tumors were reviewed. Initial surgery depended on the era of treatment and included unilateral nephrectomy (N)/partial nephrectomy (PN) and contralateral PN in 6, unilateral N/PN alone in 7, and biopsy only in 25. Chemotherapy (CT) consisted of vincristine, actinomycin-D, and adriamycin in 32 and vincristine/ actinomycin-D in 6. Radiation therapy (RT) was given to 32 patients. Treatment included both kidneys in 20, unilateral kidney plus contralateral renal bed in 9, unilateral kidney in 2, and unilateral renal bed in 1. Follow-up was 16 months to 25 years (median: 6.3 years).
  
  
  RESULTS
  Local control (LC) has been maintained in 66 out of 76 sites (87%). For Stage I-II disease with initial N/PN, LC was 10 out of 12 with RT and 11 out of 11 without RT; for Stage III with initial N/PN, LC was 8 out of 9 with RT and 1 out of 1 without RT. Initial CT and RT was followed by delayed N/PN for 20 sites; LC was 15 out of 17 in post induction Stage I-II and 1 out of 3 in postinduction Stage III. In 23 sites undergoing biopsy and chemotherapy, LC was 19 out of 20 with RT and 1 out of 3 without RT. Seven of 23 sites had a complete response (CR) after induction CT, and LC was maintained in four out of four with RT and one out of three without RT. Univariate Cox Regression analysis demonstrated that sites receiving two drugs had a statistically significant increase in loco-regional relapse when compared to sites receiving three drugs (p = 0.004). Major morbidities related to multimodality therapy have included renal failure in one patient and small bowel obstruction requiring lysis of adhesions in two patients.
  
  
  CONCLUSIONS
  Local control does not seem to be compromised by renal conservation therapy. Local control is excellent in sites treated with radiation therapy in combination with three drug chemotherapy.
authors.affiliation: Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Paulino
authors.forename: J
authors.initials: J
authors.lastname: Wilimas
authors.forename: N
authors.initials: N
authors.lastname: Marina
authors.forename: D
authors.initials: D
authors.lastname: Jones
authors.forename: M
authors.initials: M
authors.lastname: Kumar
authors.forename: C
authors.initials: C
authors.lastname: Greenwald
authors.forename: G
authors.initials: G
authors.lastname: Chen
authors.forename: L E
authors.initials: LE
authors.lastname: Kun
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D009364:Neoplasm Recurrence, Local; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D009392:Nephrectomy; D016019:Survival Analysis; D009396:Wilms Tumor / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*