The use of preoperative chemotherapy in Wilms' tumor with contained retroperitoneal rupture Journal Article

  


Authors: Rutigliano, D. N.; Kayton, M. L.; Steinherz, P.; Wolden, S.; La Quaglia, M. P.
Article Title: The use of preoperative chemotherapy in Wilms' tumor with contained retroperitoneal rupture
Abstract: Purpose: The National Wilms Tumor Study currently describes 3 indications for the use of preoperative chemotherapy: extensive caval involvement, bilateral tumors, and patients who only have a single kidney. However, the management of patients who present with a contained retroperitoneal rupture is not specifically addressed. This is relevant because of the strong possibility of peritoneal contamination when performing a primary resection and the resultant requirement for total abdominal radiation. The use of neoadjuvant chemotherapy in this subgroup of patients may be warranted. Methods: We retrospectively reviewed our experience with Wilms' tumor and identified 3 cases with contained rupture at presentation. Details of their initial evaluation and therapy, resection and pathologic findings, and follow-up constitute this report. Institutional review board waiver was obtained for the purposes of this review. Results: Two male patients, aged 2.9 years, and 1 female patient, aged 9.3 years, were identified. All patients received preoperative chemotherapy with vincristine and dactinomycin (n = 1) plus doxorubicin (n = 2) for 4 to 6 weeks before surgical resection. One patient underwent pretreatment computed tomography-guided biopsy of the kidney mass for diagnostic purposes. Presurgical computed tomographic scans showed resolution of perinephric blood and fluid with tumor shrinkage. Histopathologic analyses showed all tumors were resected with negative margins, and there was no intraoperative tumor spillage. All patients received 1050 to 1080 cGy of flank radiation postoperatively. All patients are currently alive at follow-up without evidence of local recurrence or distant disease. Conclusions: Neoadjuvant chemotherapy allowed for complete resection and avoidance of total abdominal radiation in 3 patients with ruptured Wilms' tumor and hematoma within the retroperitoneum. These data support the use of initial chemotherapy in children with retroperitoneal rupture and hematoma of Wilms' tumor at diagnosis. © 2007 Elsevier Inc. All rights reserved.
Keywords: child; child, preschool; cancer surgery; case report; doxorubicin; cancer combination chemotherapy; neoadjuvant therapy; follow up; treatment indication; antineoplastic combined chemotherapy protocols; vincristine; retrospective study; kidney neoplasms; dactinomycin; preoperative treatment; neoadjuvant chemotherapy; rupture, spontaneous; retroperitoneum; nephroblastoma; retroperitoneal space; rupture; wilms tumor; retroperitoneal; wilms' tumor
Journal Title: Journal of Pediatric Surgery
Volume: 42
Issue: 9
ISSN: 0022-3468
Publisher: W.B. Saunders Co-Elsevier Inc.  
Date Published: 2007-09-01
Start Page: 1595
End Page: 1599
Language: English
DOI: 10.1016/j.jpedsurg.2007.04.036
PUBMED: 17848255
PROVIDER: scopus
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-34548446015&partnerID=40&md5=022e98891f46d01d639ca9b142a60b77
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 17 November 2011" - "CODEN: JPDSA" - "Source: Scopus"
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MSK Authors
  1. Daniel Nicholas Rutigliano
    11 Rutigliano
  2. Michael P La Quaglia
    411 La Quaglia
  3. Suzanne L Wolden
    560 Wolden
  4. Mark Lawrence Kayton
    19 Kayton
  5. Peter G Steinherz
    221 Steinherz
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