Wilms' tumor: A 25-year review of the role of preoperative chemotherapy

Purpose: This 25-year population based, single institution review was condu cted to investigate the impact of preoperative chemotherapy on surgical and histological staging in patients with Wilms' tumors. Results: Forty-nine patients under the age of 15 years were identified from case notes to have had histologically verified Wilms' tumors over the 25-y ear period from January 1972 to December 1996. Twenty-six patients were tre ated initially with preoperative chemotherapy, 23 with immediate surgery. E leven had treatment randomized within the UKCCSG WT9101 trial (UKWT3), and the remainder received initial treatment according to unit policy. Surgical stages in the two groups (preoperative chemotherapy and immediate surgery) were respectively, stage 1: 14 (28.5%) and 11 (22.5%), stage II: one (2%) and eight (16.3%), stage III: 11 (22.5%) and four (8.2%). Seven patients ha d clinical stage IV disease at presentation. Histology results were favorab le in 45 patients and unfavorable in four. All patients received chemothera py during treatment, whereas 25 (51%) also received radiotherapy. No signif icant difference was evident in the two groups with respect to treatment-re lated morbidity. Five patients relapsed, three of whom died within the peri od of review, but a fourth has since died. Conclusions: Th is study suggests that the use of preoperative chemotherapy does not put the patient at increased risk of postoperative morbidity or r educed survival. The distribution of surgical stages suggests that limited tumor downstaging may have occurred as a result of preoperative chemotherap y. Copyright (C) 1999 by W.B. Saunders Company.