Repeat nephron-sparing surgery for children with bilateral Wilms tumor.
BACKGROUND
Renal insufficiency is a significant complication of Wilms tumor treatment in the 5% with bilateral disease. Nephron-sparing surgery (NSS) is recommended after neoadjuvant chemotherapy initially. However, the role of NSS in recurrent disease is unknown. We reviewed our experience to assess the feasibility and oncologic and functional outcomes of repeat NSS for children with recurrent disease.


METHODS
A retrospective review was performed of all children treated at our institution for bilateral, favorable histology (FH) Wilms tumor. Patients undergoing repeat NSS for locally recurrent disease were identified. The outcomes evaluated included tumor recurrence, renal function, and patient survival.


RESULTS
Since 2001, 36 children with bilateral FH Wilms tumor have been treated at our institution. Eight patients (22%) underwent repeat NSS for locally recurrent disease. Two patients had a second local recurrence and underwent a third NSS. Six patients are alive without disease (75%) with an average follow-up of 4.5years. Two patients have died, each with blastemal-predominant histology at repeat NSS. The surviving patients have normal renal function, although two patients require medical management of hypertension.


CONCLUSIONS
Our experience suggests that repeat NSS for local recurrence of FH bilateral Wilms tumor is feasible and affords acceptable oncologic outcome with preservation of renal function. However, more aggressive therapy may be required for patients whose recurrence has blastemal-predominant histology, given the poor outcome for these patients in our series.
Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA. Electronic address: Kathleen-kieran@uiowa.edu.
Kathleen
K
Kieran
Division of Urology, University of Tennessee Health Science Center, Memphis, TN.
Mark A
MA
Williams
Division of Pediatric Hematology/Oncology, Penn State Hershey Children's Hospital, Hershey, PA.
Lisa M
LM
McGregor
Division of Oncology, Children's National Medical Center, Washington, DC.
Jeffrey S
JS
Dome
Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, TN.
Matthew J
MJ
Krasin
Department of Surgery, St Jude Children's Research Hospital, Memphis, TN.
Andrew M
AM
Davidoff
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000517:prevention & control; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000601:surgery; D059351:Organ Sparing Treatments / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage; D009396:Wilms Tumor / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*
D003609:Dactinomycin; D014747:Vinblastine; D004317:Doxorubicin
Hypertension; Nephron-sparing surgery; Recurrence; Renal failure; Wilms tumor