Objective: The Children's Oncology Group study AREN0534 aimed to improve event-free survival (EFS) and overall survival (OS) while preserving renal tissue by intensifying preoperative chemotherapy, completing definitive surgery by 12 weeks from diagnosis, and modifying postoperative chemotherapy based on histologic response.
Background: No prospective therapeutic clinic trials in children with bilateral Wilms tumors (BWT) exist. Historical outcomes for this group were poor and often involved prolonged chemotherapy; on NWTS-5, 4-year EFS for all children with BWT was 56%.
Methods: Patients were enrolled and imaging studies were centrally reviewed to assess for bilateral renal lesions. They were treated with 3-drug induction chemotherapy (vincristine, dactinomycin, and doxorubicin) for 6 or 12 weeks based on radiographic response followed by surgery and further chemotherapy determined by histology. Radiation therapy was provided for postchemotherapy stage III and IV disease.
Results: One hundred eighty-nine of 208 patients were evaluable. Four-year EFS and OS were 82.1% (95% CI: 73.5%-90.8%) and 94.9% (95% CI: 90.1%-99.7%. Twenty-three patients relapsed and 7 had disease progression. After induction chemotherapy 163 of 189 (84.0%) underwent definitive surgical treatment in at least 1 kidney by 12 weeks and 39% retained parts of both kidneys. Surgical approaches included: unilateral total nephrectomy with contralateral partial nephrectomy (48%), bilateral partial nephrectomy (35%), unilateral total nephrectomy (10.5%), unilateral partial nephrectomy (4%), and bilateral total nephrectomies (2.5%).
Conclusion: This treatment approach including standardized 3-drug preoperative chemotherapy, surgical resection within 12 weeks of diagnosis and response and histology-based postoperative therapy improved EFS and OS and preservation of renal parenchyma compared with historical outcomes for children with BWT.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629006 | PMC |
| http://dx.doi.org/10.1097/SLA.0000000000002356 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Percutaneous cryoablation of renal tumours under computed tomography guidance: methodology of the procedure.
Pol J Radiol
November 2024
University Center of Excellence in Urology, Wroclaw Medical University, Wroclaw, Poland.
Purpose: The incidence of renal cell carcinoma has been steadily increasing over the past two decades, raising the need for minimally invasive approaches. We sought to present the methodology of the percutaneous cryoablation (PCA) procedure developed based on one year of experience with 81 PCA procedures.
Material And Methods: The percutaneous cryoablation programme at Wroclaw Medical University Hospital has been successfully operating for a year.
Impact of thermal denaturation on renal volume reduction after partial nephrectomy using soft coagulation hemostasis.
Sci Rep
January 2025
Department of Urology, NTT Medical Center Tokyo, 5-9-22 Higashigotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
Partial nephrectomy has become the gold standard treatment for small renal masses. This study aimed to assess the impact of soft coagulation hemostasis on parenchymal volume reduction of the operated kidney after an open partial nephrectomy. We retrospectively reviewed 94 patients with small renal tumors who underwent open partial nephrectomy with soft-coagulation hemostasis at our institution.
View Article and Find Full Text PDFCritical Care Therapy After Cytoreductive Nephrectomy for Metastatic Kidney Cancer.
Crit Care Med
January 2025
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada.
Objectives: To examine critical care therapy rates after cytoreductive nephrectomy in metastatic kidney cancer patients.
Design, Setting, And Patients: Relying on the National Inpatient Sample (2000-2019), we addressed critical care therapy use (total parenteral nutrition, invasive mechanical ventilation, renal replacement therapy, percutaneous endoscopic gastrostomy tube insertion, and tracheostomy) and in-hospital mortality in surgically treated metastatic kidney cancer patients. Estimated annual percentage changes and multivariable logistic regression models were fitted.
Innovative Integration of Robotic-Assisted Laparoscopic Telesurgery and Quantum Cryptography Communication in Urology: Clinical Application and Initial Experience.
Int J Med Robot
February 2025
Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Background: The emergence of telesurgery has received global interest, with secure network transmission identified as a crucial determinant of its success. This study aimed to evaluate the safety and viability of employing quantum cryptography communication in remote partial nephrectomy.
Methods: The surgeon operated on the patient from a distance of over 260 km using remote control of a surgical robot.
A clinical audit of adverse post-nephrectomy outcomes in renal cell carcinoma patients at a tertiary hospital in Queensland, Australia.
J Nephrol
January 2025
Townsville Hospital and Health Service, Douglas, QLD, 4814, Australia.
Background: Renal cell carcinoma (RCC) is a common malignancy, and nephrectomy is the mainstay of treatment for non-metastatic disease. The choice of surgery depends on the risks of oncologic recurrence, kidney function decline, and perioperative complications. This study aimed to identify factors associated with adverse post-operative outcomes in RCC patients undergoing nephrectomy at Townsville University Hospital (TUH).
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!