EFFECTIVENESS OF PREOPERATIVE CHEMOTHERAPY IN THE TREATMENT OF WILMS-TUMOR WITH VENA-CAVAL AND INTRACARDIAC EXTENSION

Surgical treatment of Wilms tumor with vena caval and intracardiac ext ension is challenging, often requiring cardiopulmonary bypass. We repo rt the response to preoperative chemotherapy in 3 patients following a protocol at our hospital. The tumor thrombus was limited to the infer ior vena cava in 2 patients and extended to the right atrium in 1. All 3 patients had marked reduction or complete eradication of the venous thrombus, facilitating the final surgical procedure. The patients are disease-free 18 months to 7 years after the initial treatment. Our pr otocol involves initial radiographic staging followed by needle biopsy , chemotherapy, repeat radiographic staging, definitive resection and additional chemotherapy. Our results confirm the effectiveness of this approach, which appears to decrease morbidity associated with intraca val and intra-atrial tumor extension.