Fasting Intervention for Children With Unilateral Renal Tumors to Reduce Toxicity.

Christiaan A J Oudmaijer,Hanneke M Van Santen,Marc H W Wijnen,Winnie M C Van Den Boogaard,Wilbert P Vermeij,Marc R Lilien,Daphne S J Komninos,Jan H J Hoeijmakers,Emma J Verwaaijen,Marry M Van Den Heuvel-Eibrink

doi:10.3389/fped.2022.828615

Abstract

Childhood renal tumors account for around 6% of all childhood cancers and 90% of these cases are Wilms tumor. In Europe, the SIOP-RTSG approach is considered standard of care and has resulted in five-year survival rates of over 90%. Efforts to decrease toxicity are now being pursued. Short-term fasting (STF), a short but strong reduction in calorie-intake, is associated with improved fitness, enhanced coping with acute physical stress and a lower risk of age-associated diseases. STF temporarily reduces growth to boost resilience, maintenance, and defense-mechanisms, by which toxic side-effects of (oxidative) damage and inflammation are largely prevented. Renal surgery for Wilms tumor carries a risk of acute kidney injury (AKI) and pediatric patients that had an episode of AKI are at increased risk for developing chronic renal disease. STF could mitigate surgery-induced stress and could further improve outcomes. We aim to investigate the effect of STF on renal function recovery after renal tumor surgery by conducting a single-center, prospective, randomized, non-blinded, intervention study. Children diagnosed with a unilateral renal tumor and opting for curative treatment are eligible for inclusion. The main study objective is to investigate the potential decrease in occurrence of AKI due to STF. Secondary objectives include renal function recovery, child's wellbeing, physical functioning, and feasibility of and adherence to STF in children with cancer.

Highlights

Childhood renal tumors account for around 6% of all childhood cancers [1,2,3]
Knowledge of potential benefits of preoperative fasting diets will be of extensive value for further studies and as a potential treatment strategy for future patients. With this single-center, prospective, parallel-group, non-blinded randomized controlled trial, we aim to determine the effect of short-term fasting on acute kidney injury, treatment toxicity and postoperative recovery in pediatric patients diagnosed with a Wilms tumor
Nutritional preconditioning represents a non-invasive and cost-effective method that could mitigate the effects of acute surgery-induced stress and toxicity. It has previously been associated with health benefits when exerted prolonged against age-related diseases and more acute as preconditioning method against treatment related toxicities, including kidney transplantation surgery and neoadjuvant chemotherapy in adults

Summary

Introduction

Childhood renal tumors account for around 6% of all childhood cancers [1,2,3]. Most of these cases represent Wilms tumor (WT), known as nephroblastoma [1,2,3]. Preoperative chemotherapy decreases tumor rupture risk during surgery and largely reduces the consequent need for postoperative radiotherapy [16]. It downstages the tumor and identifies an extra adverse risk group; the blastemaltype WT, which is considered a high-risk tumor that needs intensified treatment [3, 15]. Use of these international regimens, centralization of care, multimodal treatment, response tailored stratification, supportive care strategies and multidisciplinary management have resulted in a significant improvement in survival, with a current overall five-year survival rate approaching 90% [6, 7, 12,13,14,15]. A substantial proportion of WT patients carries a germline predisposition which increases kidney cancer risk, and the risk of early kidney failure [17]

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