title: Intracaval and intracardiac extension of Wilms' tumor. The influence of preoperative chemotherapy on surgical morbidity.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pediatric Oncology, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil. liliancristofani@uol.com.br
authors.forename: Lilian M
authors.initials: LM
authors.lastname: Cristofani
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Duarte
authors.forename: Maria T
authors.initials: MT
authors.lastname: Almeida
authors.forename: Vicente
authors.initials: V
authors.lastname: Odone Filho
authors.forename: Joao G
authors.initials: JG
authors.lastname: Maksoud
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003609:Dactinomycin / Q000008:administration & dosage*; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000473:pathology*; D014750:Vincristine / Q000008:administration & dosage*; D009396:Wilms Tumor / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents; D003609:Dactinomycin; D014750:Vincristine