LOCAL-CONTROL IN SYNCHRONOUS BILATERAL WILMS-TUMOR

Purpose: To evaluate the role of radiation therapy (RT), chemotherapy (CT), and surgery in the local control of synchronous bilateral Wilms Tumor (WT). Methods and Materials: Between 1962 to 1993, 45 children w ere treated for bilateral WT; 38 patients with synchronous tumors were reviewed. Initial surgery depended on the era of treatment and includ ed unilateral nephrectomy (N)/partial nephrectomy (PN) and contralater al PN in 6, unilateral N/PN alone in 7, and biopsy only in 25. Chemoth erapy (CT) consisted of vincristine, actinomycin-D, and adriamycin in 32 and vincristine/actinomycin-D in 6. Radiation therapy (RT) was give n to 32 patients. Treatment included both kidneys in 20, unilateral ki dney plus contralateral renal bed in 9, unilateral kidney in 2, and un ilateral renal bed in 1. Followup was 16 months to 25 years (median: 6 .3 years). Results: Local control (LC) has been maintained in 66 out o f 76 sites (87%). For Stage I-II disease with initial N/PN, LC was 10 out of 12 with RT and 11 out of 11 without RT; for Stage III with init ial N/PN, LC was 8 out of 9 with RT and 1 out of 1 without RT. Initial CT and RT was followed by delayed N/PN for 20 sites; LC was 15 out of 17 in post induction Stage I-II and 1 out of 3 in postinduction Stage m. In 23 sites undergoing biopsy and chemotherapy, LC was 19 out of 2 0 with RT and 1 out of 3 without RT. Seven of 23 sites had a complete response (CR) after induction CT, and LC was maintained in four out of four with RT and one out of three without RT. Univariate Cox Regressi on analysis demonstrated that sites receiving two drugs had a statisti cally significant increase in loco-regional relapse when compared to s ites receiving three drugs (p = 0.004). Major morbidities related to m ultimodality therapy have included renal failure in one patient and sm all bowel obstruction requiring lysis of adhesions in two patients. Co nclusions: Local control does not seem to be compromised by renal cons ervation therapy. Local control is excellent in sites treated with rad iation therapy in combination with three drug chemotherapy. Copyright (C) 1996 Elsevier Science Inc.