Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy.

Anouk Steur,Annemieke S Littooij,Cornelis P Van De Ven,Ronald R De Krijger,Geert O Janssens,Harm Van Tinteren,Marc R Lilien,Alida F W Van Der Steeg,Martin C J Kneyber,Sandra Dijkstra,Dick A Van Waardenburg,Martine Van Grotel,Job B M Van Woensel,Annelies M C Mavinkurve‐Groothuis ,Paulien Raymakers-Janssen ,Marc H W A Wijnen ,Annemarie M.l Peek ,Godelieve A.m Tytgat ,Marry M Van Den Heuvel‐Eibrink ,Roelie M Wösten–Van Asperen

doi:10.3390/cancers14040943

Abstract

Simple SummarySurvival of children with Wilms tumor is excellent. However, treatment-related complications may occur, requiring treatment at the pediatric intensive care unit (PICU). The aim of our retrospective study was to assess the frequency, clinical characteristics, and outcome of 175 children with Wilms tumor requiring treatment at the PICU in the Netherlands. Thirty-three patients (almost 20%) required unplanned PICU admission during their disease course. Younger age at diagnosis, intensive chemotherapy regimens, and bilateral tumor surgery were risk factors for these unplanned PICU admissions. Three children required renal replacement therapy, two of which continued dialysis after PICU discharge. Two children died during their PICU stay. During follow up, hypertension and renal dysfunction were frequently observed, which justifies special attention for kidney function and blood pressure monitoring during and after treatment of these children.Survival rates are excellent for children with Wilms tumor (WT), yet tumor and treatment-related complications may require pediatric intensive care unit (PICU) admission. We assessed the frequency, clinical characteristics, and outcome of children with WT requiring PICU admissions in a multicenter, retrospective study in the Netherlands. Admission reasons of unplanned PICU admissions were described in relation to treatment phase. Unplanned PICU admissions were compared to a control group of no or planned PICU admissions, with regard to patient characteristics and short and long term outcomes. In a multicenter cohort of 175 children with an underlying WT, 50 unplanned PICU admissions were registered in 33 patients. Reasons for admission were diverse and varied per treatment phase. Younger age at diagnosis, intensive chemotherapy regimens, and bilateral tumor surgery were observed in children with unplanned PICU admission versus the other WT patients. Three children required renal replacement therapy, two of which continued dialysis after PICU discharge (both with bilateral disease). Two children died during their PICU stay. During follow-up, hypertension and chronic kidney disease (18.2 vs. 4.2% and 15.2 vs. 0.7%) were more frequently observed in unplanned PICU admitted patients compared to the other patients. No significant differences in cardiac morbidity, relapse, or progression were observed. Almost 20% of children with WT required unplanned PICU admission, with young age and treatment intensity as potential risk factors. Hypertension and renal impairment were frequently observed in these patients, warranting special attention at presentation and during treatment and follow-up.

Highlights

Childhood renal tumors account for approximately 6% of all pediatric malignancies [1].The majority of these tumors are Wilms tumors (WT)
Our study shows that almost 20% of children with WT require unplanned pediatric intensive care unit (PICU) admission during the course of first-line treatment and followup, of which one-third is before the start of any treatment as a result of tumor-related complications
Hypertension is mainly based on activation of the renin-angiotensin aldosterone system (RAAS) by renin overproduction, in WT caused by local kidney ischemia due to vascular compression by large tumors, as well as directly by the blastemal component of the WT [25,26]

Summary

Introduction

Childhood renal tumors account for approximately 6% of all pediatric malignancies [1].The majority of these tumors are Wilms tumors (WT). Advances in treatment strategies have led to an excellent outcome for children with localized WT, future challenges lie in improving survival of specific subgroups and decreasing direct as well as and late toxic effects of treatment [2,3,4,5,6]. These treatment-related toxicities can require admission to the pediatric intensive care (PICU). These cases revealed relatively well-known emergencies associated with WT at presentation, such as malignant hypertension and extensive (intracardial) tumor thrombus, and postoperative hemorrhage, cardiomyopathy and hepatotoxicity, intracranial bleeding, and seizures [8,9,10,11,12,13,14,15,16,17,18]

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