Nephrectomy Alone for Some Children-Wilms Tumor


BUFFALO, NY - The current "standard" treatment for children who have favorable histology Wilms tumor (cancer of the kidney) includes nephrectomy (removal of the kidney), followed by combination chemotherapy with or without radiation therapy.

However, a study by the National Wilms Tumor Study Group (NWTSG) has determined that nephrectomy alone might be sufficient treatment for children less than 24 months of age, with a stage I/favorable histology Wilms tumor weighing less than 550 grams. Results are published in the Journal of Clinical Oncology (September 1, 2001).

"The impetus for this NWTSG study was that available data suggested that the costs of the 'standard' treatment - medical, financial and emotional factors - may outweigh the benefits for this select group of children," according to Daniel M. Green, MD, Department of Pediatrics at Roswell Park Cancer Institute, and lead author of the report.

"It's too early to recommend nephrectomy alone as standard treatment for infants with small, stage I/favorable histology Wilms tumor," he notes. "But, the results of the study justify further investigation of this approach in a new prospective clinical trial designed to define more accurately a population of patients for whom this treatment might be the most appropriate."

The NWTSG study evaluated nephrectomy alone in 75 previously untreated children less than 24 months of age with stage I/favorable histology Wilms tumor for which the surgical specimen weighed less than 550 grams; 37 females and 38 males. Eleven patients relapsed or later developed cancer in the other kidney.

The two-year disease-survival rate was 86.5 percent and the two-year survival rate was 100 percent, with a median follow up of 2.84 years.

"We conclude that the relapse-free survival rate of children with stage I/favorable histology Wilms tumor treated with nephrectomy alone is marginally inferior to that of children treated on previous NWTSG studies with nephrectomy, vincristine and dactinomycin," notes Green.

"However, the increase in relapse rate did not result in inferior survival due to the very high success rate of treatment for children with recurrent disease."

This study also provided new information about the biologic potential of tumors with or without several pathologic features; specifically, no child with an epithelial, tubular differentiation Wilms tumor developed disease recurrence or a later cancer in the other kidney.

However, the authors point out that a study of a larger group of such patients would be needed to confirm the statistical significance of this type of Wilms tumor and a favorable outcome following treatment with nephrectomy alone. The same is true for information gleaned from the study on the impact, if any, of chemotherapy on the conversion of nephrogenic rests to Wilms tumor.

Roswell Park Cancer Institute, founded in 1898, is the nationís first cancer research, treatment and education center and is the only National Cancer Institute-designated comprehensive cancer center in Western New York.

Microvessel Density & Ped Optic Pathway/Hypothalmic Gliomas

Abstract # 1556 ASCO, 2004

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