SHANGHAI, CHINA—Adding preoperative chemotherapy to the protocol for children with Wilms' tumor appears to increase overall survival rates from 78% to 90%, according to a presentation here at the 4th Congress of the International Society of Pediatric Oncology-Asia (SIOP-Asia).
Seung Hoon Choi, MD, PhD, Professor in the Department of Surgery at Yonsei University College of Medicine in Seoul, reported that the 78% overall survival rate in this retrospective study was for the 1986–1995 period, when preoperative chemotherapy was not used; and 90% for 1996–2005 when preoperative chemotherapy was used. All patients were treated at a kidney center in a major Korean teaching hospital.
The preoperative regimen included actinomycin D and doxorubicin, and the data represented Dr. Choi's 20 years of experience treating Wilms' tumor at his institution.
Multivariate analysis found that in those 20 years, the most significant prognostic factor affecting survival was tumor spillage or rupture during operation.
The university hospital, Yongdong Severance Hospital, Seoul, adopted the SIOP policy of administering three to five courses of preoperative chemotherapy in 1996.
“If the tumor is big and at an advanced stage, preoperative chemotherapy is very important because it reduces the incidence of tumor spillage,” Dr. Choi said. “By doing so we can reduce the incidence of tumor spillage and rupture because the tumor mass is reduced in size.”
Besides meticulous surgical technique, other prognostic factors were patient age at diagnosis, early diagnosis, pathologic stage, tumor cell anaplasia, and proper preoperative or postoperative adjuvant chemotherapy or radiotherapy according to tumor histology.
With a median follow-up of eight years, local recurrence of distant metastasis was found in 15 patients, and nine patients died from the disease.
Wilms' tumor occurs most often at three years of age, and is rare after age eight.
This study of data from March 1986 to March 2005 included 68 Wilms' tumor patients: 23 with Stage I, 21 with Stage II, 13 with Stage IV, and four with Stage V.
Males accounted for 40 patients, and females, 28. Median age at diagnosis was 25 months.
Neoadjuvant chemotherapy was performed in 27 patients, and initial nephrectomy followed by chemotherapy in the other 41. Postoperative radiotherapy was performed in 27.
Preoperative and adjuvant chemotherapy is given routinely in his institution to Wilms' tumor patients with Stage 2–4 disease, Dr. Choi said.
Difficult to Interpret
A US oncologist attending the meeting was asked afterwards to comment on the paper.
Daniel M. Green, MD, Staff Physician and Director of the Long-Term Follow-Up Clinic in the Department of Pediatrics at Roswell Park Cancer Institute, explained that the study's results are difficult to interpret because they represent outcomes of two sequential treatment policies, not the results of a randomized trial.
“There has been a debate for almost 30 years now regarding the risks and benefits of preoperative chemotherapy,” Dr. Green said.