| The Role of Neoadjuvant Chemotherapy for
Advanced Stage Wilms Tumor |
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Chang Kyu Kang1, Kwang Bin Moon1, Keon Hee Yoo1, Hong Hoe Koo1, Hye Kyung Yoon2, Kwan Hyun Park3 |
1Department of Pediatrics, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Radiology, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
3Department of Urology, Samsung Seoul Hospital,Sungkyunkwan University School of Medicine, Seoul, Korea |
| 진행된 Wilms 종양에서 수술 전 항암화학요법의 의의 |
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강창규1, 문광빈1, 유건희1, 구홍회1, 윤혜경2, 박관현3 |
1성균관대학교 의과대학 삼성서울병원 소아과
2성균관대학교 의과대학 삼성서울병원 영상의학과
3성균관대학교 의과대학 삼성서울병원 비뇨기과 |
Correspondence:
Hong Hoe Koo, Email: hhkoo@smc.samsung.co.kr
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| Abstract |
Purpose
: This study was designed to exclude radiation in advanced(stage 3, 4) Wilms tumor (WT) by increasing the chance of complete surgical removal with preceding neoadjuvant chemotherapy, thereby reducing the incidence of late effects.
Methods
: Between December 1998 and July 2002, we conducted neoadjuvant chemotherapy after needle aspiration biopsy on patients who had advanced WT. If needle biopsy was accessible, we conducted neoadjuvant chemotherapy(vincristine, adriamycin, dactinomycin) for 12 weeks and then performed surgical removal, excluded radiation therapy and conducted postoperative chemotherapy (vincristine, dactinomycin켥driamycin). In other cases, we firstly conducted the operation and then performed radiation and postoperative chemotherapy.
Results
: Of the 17 patients diagnosed as WT, 12 patients had an advanced stage of disease. In two of the 12 patients, initial surgical removal was conducted. The median age of patients was 21 months(5-103 months). Of the 10 the patients who received neoadjuvant chemotherapy, eight patients were stage 1, one patient was stage 2, and the other was stage 3 at operation. In nine patients except one with stage 3 disease, we could perform complete surgical resection and therefore could omit radiation. In four cases we could also exclude adriamycin after operation. All but one patient was alive, disease-free, for a median follow-up of 21 months(9-43 months).
Conclusion
: After neoadjuvant chemotherapy, we could increase the chance of complete tumor resection, exclude radiation and decrease the intensity of postoperative chemotherapy in selected cases. Long term follow-up is needed to determine whether our method would significantly decrease late effects. |
| Key Words:
Neoadjuvant chemotherapy, Wilms tumor |
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