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:
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.