The role of pulmonary computed tomography in the management of Wilms' tumour

Abstract

The staging and therapy of Wilms' tumour is based on data collected before the availability of computed tomography. It is established in the adult population that chest CT scan may reveal metastatic lesions not apparent on chest radiographs; no such data have been published regarding childhood malginancies. A total of 453 children with Wilms' tumour was entered into the United Kingdom Children's Cancer Study Group (UKCCSG) study, between June 1986 and October 1991; 359 had normal chest radiographs at presentation, of which 142 had pulmonary CT scans performed at that time. In all, 31 of the 142 patients with normal chest radiographs had abnormal pulmonary CT scans, and, on review, 7/31 patients who were CT scan positive and chest radiograph negative have since relapsed, four of these in the lung, giving a pulmonary relapse rate of 13% compared with an overall pulmonary relapse rate for all states of 6%. This itself is not statistically significant. However, on reviewing the data for Stage I patients alone (n=56), 7 were CT scan positive and chest radiograph negative, and 3 of these 7 patients (43%) have since relapsed, all with pulmonary disease. This compares with a pulmonary relapse rate of 4/49 (8%) for Stage I patients with a normal presenting pulmonary CT scan. Hence computed tomography identifies a sub-group of Stage I patients with an increased risk of pulmonary relapse. This may reflect minimal pulmonary disease which is inadequately treated. A Comprehensive Programme for Mutant Gene Carrier Detection in Retinoblastoma Patients