title: A retrospective study of the preoperative treatment of advanced Wilms tumor in children with chemotherapy versus transcatheter arterial chemoembolization alone or combined with short-term systemic chemotherapy.
abstract: OBJECTIVE
  To evaluate the therapeutic effect of preoperative transcatheter arterial chemoembolization (TACE) combined with short-term systematic chemotherapy in the treatment of advanced Wilms tumor.
  
  
  METHODS
  This was a retrospective study on 66 patients with unilateral advanced Wilms tumor, age 5 months to 11 years (median, 2.9 years; 30 boys and 36 girls), treated at our institution between 1995 and 2007. Characteristics of the patient population were maximal tumor diameter > 10 cm, or involvement of periaortic lymph nodes, or inferior vena cava invasion, or distal metastasis, or tumor with anaplastic histology. Patients were divided into three groups. Twenty patients were treated with conventional preoperative chemotherapy (PC group) using vindesine, actinomycin D, and pirarubicin for 4 weeks; 21 patients were treated in the TACE group with preoperative renal arterial chemoembolization using Lipiodol-pirarubicin-vindesine emulsion; and 25 patients were treated with preoperative chemoembolization combined with short-term systematic chemotherapy (T+S) for 2 weeks.
  
  
  RESULTS
  No drug-induced cardiotoxicity, nephrotoxicity, or hepatic dysfunction was observed. Complete surgical removal of the tumor was achieved in 12 (65.0%), 17 (80.9%), and 22 (88.0%) patients in the PC, TACE, and T+S groups, respectively (T+S group vs PC group, P = .030). The 2-year relapse-free survival rates were 65.0%, 80.9%, and 100.0% in the PC, TACE, and T+S groups, respectively (T+S vs PC, P = .001).
  
  
  CONCLUSIONS
  From our experience, preoperative chemoembolization combined with short-term systematic chemotherapy is able to achieve higher rates of complete tumor resection and relapse-free survival in the treatment of advanced Wilms tumor.
authors.affiliation: Division of Pediatric Surgical Oncology, Department of Pediatric Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. minjuli@hzcnc.com
authors.forename: Min-Ju
authors.initials: MJ
authors.lastname: Li
authors.forename: Yin-Bao
authors.initials: YB
authors.lastname: Zhou
authors.forename: Yong
authors.initials: Y
authors.lastname: Huang
authors.forename: Da-Xing
authors.initials: DX
authors.lastname: Tang
authors.forename: Shan
authors.initials: S
authors.lastname: Xu
authors.forename: De-Hua
authors.initials: DH
authors.lastname: Wu
authors.forename: Yi-Ying
authors.initials: YY
authors.lastname: Zhang
authors.forename: Hong-Feng
authors.initials: HF
authors.lastname: Tang
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D002681:China; D003609:Dactinomycin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009392:Nephrectomy; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014751:Vindesine / Q000008:administration & dosage; D009396:Wilms Tumor / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery
chemical_list: D003609:Dactinomycin; D004998:Ethiodized Oil; D004317:Doxorubicin; C027260:pirarubicin; D014751:Vindesine