High local recurrence of Wilms tumor: A single institutional experience at western region of Saudi Arabia

Abstract

8559 Background: Controversy exists between an initial surgical resection versus preoperative chemotherapy in the management of Wilms’ tumor. Objective: Evaluate effect of a pre-operative approach in the management of Wilms’ tumor in terms of local recurrence and survival versus early nephrectomy. Methods: A retrospective review was undertaken of patients with Wilms’ tumor treated from 1986–2000. Pathology was reviewed using NWTS V criteria. Staging and treatment were based on the UKW3 protocol. Patients were evaluated for local recurrence and survival. Results: Thirty-five patients (16 male) were treated during the study period. Stage distribution was Stage I 4 pts. Stage II 8 pts. Stage III 14 pts. Stage IV 4 pts. Stage V 5 pts. Histology was favorable (FH) in 31, the unfavorable cases were; anaplastic 2, clear cell sarcoma 1, rhabdoid 1. Eight patients 8/35 (23%) developed local recurrence (LR). Six isolated, One patient had simultaneous local and distant (lung) recurrence and another pt.developed second local recurrence after isolated first pulmonary recurrence and an additional pt.developed isolated pulmonary recurrence. Thirteen (13) pts.were subjected to pre-operative chemotherapy (POC); 19 pts.were subjected to early surgery and 3 pts. data not available. Two (2) of 13 patients receiving pre-operative chemotherapy were UH compared to 2/19 patients treated with initial resection. Stage distribution of patients receiving POC was: Stage III 5; Stage IV 3; Stage V 5. LR occurred in 6 /13 (46%) patients receiving POC compared to 2/19 (10%) in patients having initial resection. Survival by histology was FH 80% and UH 25%. All local recurrece died except isolated pulmonary recurrence. Conclusions: Cytoreduction approach using Actinomycin-D and Vincristine was applied to Stage V and to Stage IV patients. The high local recurrence rate seen in our population is attributed to unfavorable histology, unresectable tumor, stage III & stage IV disease and the prolonged delay in initiation of definite therapy to primary lesion. Many of our patients were deemed inoperable at diagnosis. Earlier surgical intervention or early utilization of irradiation in inoperable cases might reduce our high recurrence rate. No significant financial relationships to disclose.