OBJECTIVETo evaluate the efficacy and safety of the WT-2009 chemotherapy protocol for Wilms' tumor (WT) in children.

METHODSThe clinical data of 34 children with newly-diagnosed WT between July 2009 and December 2013 were retrospectively analyzed. Among the 34 children, 2 died before treatment, 6 children did not accept therapy and 26 accepted the chemotherapy based on the WT-2009 chemotherapy protocol. Kaplan-Meier method was used to estimate the 2-year survival rate.

RESULTSThe pathological analysis revealed the favorable histology WT was common (88%, 30/34). The most common first manifestation was abdominal masses (56%, 19/34). Among the 26 patients who accepted the chemotherapy based on the WT-2009 protocol, complete remission was achieved in 24 cases (92%), partial remission was achieved in 1 case (4%), and disease relapse was found in 1 case (4%). Severe pulmonary infection occurred in 1 case in the course of treatment. The 2-year overall survival rate and event-free survival rate were 100% and 89.7% respectively.

CONCLUSIONSFavorable histology is most common pathological type in children with WT. The chemotherapy based on the WT-2009 protocol for WT can produce a favorable prognosis and a high tolerance.

Antineoplastic Agents ; adverse effects ; therapeutic use ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Kidney Neoplasms ; drug therapy ; mortality ; pathology ; Male ; Survival Rate ; Wilms Tumor ; drug therapy ; mortality ; pathology

The survival in cases with relapsed Wilms tumor is dismal. Recently, however the introduction of new therapeutic agents and experimental strategies has improved the survival. We analysed the survival of patients with relapsed Wilms tumor according to the treatment period. During the early period 1983-1993, patients who had received two drugs were treated with doxorubicin and the others were treated with cisplatin and etoposide, whereas during the late period 1994-2004, patients were treated with combinations of cyclophosphamide/etoposide and carboplatin/etoposide. During the early period, 8 of 57 experienced relapse, and 8 of 41 relapsed during the late period. Only 2 patients treated during the early period survived in complete response (CR), whereas during the late period, 5 patients remained alive in CR, and 3 of those received high-dose chemotherapy (HDC) with autologous peripheral stem cell rescue (SCR). The estimated 5 yr event-free survival rate was 37.5% in the entire study group, 50% for patients in the late period, and 25% for patients in the early period (p=0.38). The survival in patients with relapsed Wilms tumor dramatically improved during the late period and HDC with SCR was one of the effective salvage strategies.
Wilms Tumor/*mortality/*pathology ; Treatment Outcome ; Time Factors ; *Recurrence ; *Peripheral Blood Stem Cell Transplantation ; Male ; Korea ; Infant ; Humans ; Female ; Disease-Free Survival ; Child, Preschool ; Child ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use

OBJECTIVETo improve prognosis of the patients with advanced Wilms' tumor, the authors compared different therapeutic strategies including preoperative transcatheter arterial chemoembolization (TACE), conventional preoperative chemotherapy and initial surgery.

METHODSSixty-two patients aged from 5 months to 10 years (mean 3.2 years) were identified from medical records to have histologically confirmed advanced Wilms' tumor during the period from January 1993 to December 2002. The criteria for choice were huge tumor size with a volume more than 550 ml or the mass extending beyond the midline, involvement of vital structures, inferior vena cava invasion, distal metastasis or bilateral Wilms' tumor judged by imaging examination. All cases were divided into 3 groups according to the treatment received: 31 cases in group TACE received preoperative transcatheter arterial chemoembolization with Lipiodol-Epirubicin (EPI)-Vincristine emulsion. One week after TACE, systemic chemotherapy with Actinomycin D (ACTD) was administered and tumor resected at two weeks after TACE. 20 cases in group PC received conventional preoperative chemotherapy with VCR, ACTD plus EPI for 4-5 weeks, and 11 cases in group IS underwent initial surgery. Postoperative treatment for all patients was based on the postoperative staging and tumor histology.

RESULTSIn the patients treated with TACE, no drug-induced complications such as cardiotoxicity, nephrotoxicity, hepatic dysfunction or bone marrow suppression were observed except for mild fever due to tumor necrosis. The percentages of tumor size shrinkage were 32.4% and 20.3% in group TACE and group PC, respectively (P < 0.05). Complete surgical removal of the tumor was achieved in 27 patients (87.1%) in group TACE, significantly higher in comparison with 14 in group PC (70.0%, P < 0.05) and 2 in group IS (18.2%, P < 0.01). Event-free survival (EFS) at 2 years was 87.1% (27/ 31), 60.0% (12/20) and 18.2% (2/11), respectivrely. EFS at 4 years was 84.6% (11/13), 56.3% (9/16 ) and 18.2% (2/11) in groups TACE, PC and IS, respectively.

CONCLUSIONThe present study has shown that both preoperative TACE and conventional preoperative chemotherapy can be applied to the patients with advanced Wilms' tumor who are not candidates for immediately surgical resection. The survival is significantly increased in the patients undergoing preoperativeTACE when compared with conventional preoperative chemotherapy and initial surgery.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Chemoembolization, Therapeutic ; Child ; Child, Preschool ; Combined Modality Therapy ; Dactinomycin ; administration & dosage ; Disease-Free Survival ; Epirubicin ; administration & dosage ; Female ; Follow-Up Studies ; Humans ; Infant ; Iodized Oil ; administration & dosage ; Kidney Neoplasms ; mortality ; pathology ; therapy ; Male ; Neoplasm Staging ; Nephrectomy ; Preoperative Care ; Survival Rate ; Treatment Outcome ; Vincristine ; administration & dosage ; Wilms Tumor ; pathology ; therapy