Management and Outcomes of Wilms Tumor With Suprarenal Intravascular Extension : A Pediatric Surgical Oncology Research Collaborative Study
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc..
OBJECTIVE: The purpose of this study was to describe management and outcomes from a contemporary cohort of children with Wilms tumor complicated by inferior vena caval thrombus.
BACKGROUND: The largest series of these patients was published almost 2 decades ago. Since then, neoadjuvant chemotherapy has been commonly used to manage these patients, and outcomes have not been reported.
METHODS: Retrospective review of 19 North American centers between 2009 and 2019. Patient and disease characteristics, management, and outcomes were investigated and analyzed.
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 postresection 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%. The perioperative complication rate was significantly lower after 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 was 93% and overall survival was 96%, higher in FH cases (FH 98% vs unfavorable histology/anaplastic 82%; P =0.73). Neither incomplete resection nor viable thrombus cells affected event-free survival or overall survival.
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.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:279 |
|---|---|
| Enthalten in: |
Annals of surgery - 279(2024), 3 vom: 01. Feb., Seite 528-535 |
| Sprache: |
Englisch |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 02.02.2024 Date Revised 02.02.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1097/SLA.0000000000005921 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM357669827 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM357669827 | ||
| 003 | DE-627 | ||
| 005 | 20240202231947.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1097/SLA.0000000000005921 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1278.xml |
| 035 | |a (DE-627)NLM357669827 | ||
| 035 | |a (NLM)37264925 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Naik-Mathuria, Bindi |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Management and Outcomes of Wilms Tumor With Suprarenal Intravascular Extension |b A Pediatric Surgical Oncology Research Collaborative Study |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 02.02.2024 | ||
| 500 | |a Date Revised 02.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. | ||
| 520 | |a OBJECTIVE: The purpose of this study was to describe management and outcomes from a contemporary cohort of children with Wilms tumor complicated by inferior vena caval thrombus | ||
| 520 | |a BACKGROUND: The largest series of these patients was published almost 2 decades ago. Since then, neoadjuvant chemotherapy has been commonly used to manage these patients, and outcomes have not been reported | ||
| 520 | |a METHODS: Retrospective review of 19 North American centers between 2009 and 2019. Patient and disease characteristics, management, and outcomes were investigated and analyzed | ||
| 520 | |a 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 postresection 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%. The perioperative complication rate was significantly lower after 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 was 93% and overall survival was 96%, higher in FH cases (FH 98% vs unfavorable histology/anaplastic 82%; P =0.73). Neither incomplete resection nor viable thrombus cells affected event-free survival or overall survival | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Utria, Alan F |e verfasserin |4 aut | |
| 700 | 1 | |a Ehrlich, Peter F |e verfasserin |4 aut | |
| 700 | 1 | |a Aldrink, Jennifer H |e verfasserin |4 aut | |
| 700 | 1 | |a Murphy, Andrew J |e verfasserin |4 aut | |
| 700 | 1 | |a Lautz, Timothy |e verfasserin |4 aut | |
| 700 | 1 | |a Dasgupta, Roshni |e verfasserin |4 aut | |
| 700 | 1 | |a Short, Scott S |e verfasserin |4 aut | |
| 700 | 1 | |a Lovvorn, Harold N |c 3rd |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Eugene S |e verfasserin |4 aut | |
| 700 | 1 | |a Newman, Erica |e verfasserin |4 aut | |
| 700 | 1 | |a Lal, Dave R |e verfasserin |4 aut | |
| 700 | 1 | |a Rich, Barrie S |e verfasserin |4 aut | |
| 700 | 1 | |a Piché, Nelson |e verfasserin |4 aut | |
| 700 | 1 | |a Kastenberg, Zachary J |e verfasserin |4 aut | |
| 700 | 1 | |a Malek, Marcus M |e verfasserin |4 aut | |
| 700 | 1 | |a Glick, Richard D |e verfasserin |4 aut | |
| 700 | 1 | |a Petroze, Robin T |e verfasserin |4 aut | |
| 700 | 1 | |a Polites, Stephanie F |e verfasserin |4 aut | |
| 700 | 1 | |a Whitlock, Richard |e verfasserin |4 aut | |
| 700 | 1 | |a Alore, Elizabeth |e verfasserin |4 aut | |
| 700 | 1 | |a Sutthatarn, Pattamon |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Stephanie Y |e verfasserin |4 aut | |
| 700 | 1 | |a Wong-Michalak, Shannon |e verfasserin |4 aut | |
| 700 | 1 | |a Romao, Rodrigo Lp |e verfasserin |4 aut | |
| 700 | 1 | |a Al-Hadidi, Ameer |e verfasserin |4 aut | |
| 700 | 1 | |a Rubalcava, Nathan S |e verfasserin |4 aut | |
| 700 | 1 | |a Marquart, John P |e verfasserin |4 aut | |
| 700 | 1 | |a Gainer, Hailey |e verfasserin |4 aut | |
| 700 | 1 | |a Johnson, Mike |e verfasserin |4 aut | |
| 700 | 1 | |a Boehmer, Chloe |e verfasserin |4 aut | |
| 700 | 1 | |a Rinehardt, Hannah |e verfasserin |4 aut | |
| 700 | 1 | |a Seemann, Natashia M |e verfasserin |4 aut | |
| 700 | 1 | |a Davidson, Jacob |e verfasserin |4 aut | |
| 700 | 1 | |a Polcz, Valerie |e verfasserin |4 aut | |
| 700 | 1 | |a Lund, Sarah B |e verfasserin |4 aut | |
| 700 | 1 | |a McKay, Katlyn G |e verfasserin |4 aut | |
| 700 | 1 | |a Correa, Hernan |e verfasserin |4 aut | |
| 700 | 1 | |a Rothstein, David H |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Annals of surgery |d 1885 |g 279(2024), 3 vom: 01. Feb., Seite 528-535 |w (DE-627)NLM000026654 |x 1528-1140 |7 nnns |
| 773 | 1 | 8 | |g volume:279 |g year:2024 |g number:3 |g day:01 |g month:02 |g pages:528-535 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1097/SLA.0000000000005921 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 279 |j 2024 |e 3 |b 01 |c 02 |h 528-535 | ||