Management and Outcomes of Wilms Tumor with Suprarenal Intravascular Extension: A Pediatric Surgical Oncology Research Collaborative Study.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
02 Jun 2023
02 Jun 2023
Historique:
medline:
2
6
2023
pubmed:
2
6
2023
entrez:
2
6
2023
Statut:
aheadofprint
Résumé
The purpose of this study was to describe management and outcomes from a contemporary cohort of children with Wilms Tumor (WT) complicated by inferior vena caval thrombus. The largest series of these patients was published almost two decades ago. Since then, neoadjuvant chemotherapy has been commonly used to manage these patients and outcomes have not been reported. Retrospective review from 19 North American centers between 2009-2019. Patient and disease characteristics, management, and outcomes were investigated and analyzed. Of 124 patients, 81% had favorable histology (FH), and 52% were stage IV. IVC thrombus level was infrahepatic in 53 (43%), intrahepatic in 32 (26%), suprahepatic in 14 (11%), and cardiac in 24 (19%). Neoadjuvant chemotherapy using a 3-drug regimen was administered in 82% and post-resection radiation in 90%. Thrombus level regression was 45% overall, with suprahepatic level showing the best response (62%). Cardiopulmonary bypass (CPB) was potentially avoided in 67%. Peri-operative complication rate was significantly lower following neoadjuvant chemotherapy ([25%] vs. Upfront surgery [55%]; P=0.005). CPB was not associated with higher complications (CPB [50%] vs. no CPB [27%]; P=0.08). Two-year event-free survival (EFS) was 93% and overall survival (OS) was 96%, higher in FH cases (FH 98% vs. unfavorable histology/anaplastic 82%; P=0.73). Neither incomplete resection nor viable thrombus cells affected EFS or OS. Multimodal therapy resulted in excellent outcomes, even with advanced stage disease and cardiac extension. Neoadjuvant chemotherapy decreased the need for CPB to facilitate resection. Complete thrombectomy may not always be necessary.
Sections du résumé
OBJECTIVE
OBJECTIVE
The purpose of this study was to describe management and outcomes from a contemporary cohort of children with Wilms Tumor (WT) complicated by inferior vena caval thrombus.
SUMMARY BACKGROUND DATA
BACKGROUND
The largest series of these patients was published almost two decades ago. Since then, neoadjuvant chemotherapy has been commonly used to manage these patients and outcomes have not been reported.
METHODS
METHODS
Retrospective review from 19 North American centers between 2009-2019. Patient and disease characteristics, management, and outcomes were investigated and analyzed.
RESULTS
RESULTS
Of 124 patients, 81% had favorable histology (FH), and 52% were stage IV. IVC thrombus level was infrahepatic in 53 (43%), intrahepatic in 32 (26%), suprahepatic in 14 (11%), and cardiac in 24 (19%). Neoadjuvant chemotherapy using a 3-drug regimen was administered in 82% and post-resection radiation in 90%. Thrombus level regression was 45% overall, with suprahepatic level showing the best response (62%). Cardiopulmonary bypass (CPB) was potentially avoided in 67%. Peri-operative complication rate was significantly lower following neoadjuvant chemotherapy ([25%] vs. Upfront surgery [55%]; P=0.005). CPB was not associated with higher complications (CPB [50%] vs. no CPB [27%]; P=0.08). Two-year event-free survival (EFS) was 93% and overall survival (OS) was 96%, higher in FH cases (FH 98% vs. unfavorable histology/anaplastic 82%; P=0.73). Neither incomplete resection nor viable thrombus cells affected EFS or OS.
CONCLUSIONS
CONCLUSIONS
Multimodal therapy resulted in excellent outcomes, even with advanced stage disease and cardiac extension. Neoadjuvant chemotherapy decreased the need for CPB to facilitate resection. Complete thrombectomy may not always be necessary.
Identifiants
pubmed: 37264925
doi: 10.1097/SLA.0000000000005921
pii: 00000658-990000000-00480
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.