All issues > Volume 45(12); 2002

Original Article

J Korean Pediatr Soc. 2002;45(12):1534-1539. Published online December 15, 2002.

The Role of Neoadjuvant Chemotherapy for Advanced Stage Wilms Tumor

Chang Kyu CK Kang¹, Kwang Bin KB Moon¹, Keon Hee KH Yoo¹, Hong Hoe HH Koo¹, Hye Kyung HK Yoon², Kwan Hyun KH 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

Correspondence Hong Hoe HH Koo ,Email: hhkoo@smc.samsung.co.kr

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.

Keywords :Neoadjuvant chemotherapy, Wilms tumor