The role of renal salvage procedures for bilateral Wilms tumor: A 15-year review

Purpose: We reviewed our experience with renal salvage procedures in patien ts with bilateral Wilms tumor to determine the clinical outcome. Materials and Methods: From 1982 to 1997, 23 children with bilateral Wilms tumor were treated with partial nephrectomy at our institution, including 7 who were also treated with brachytherapy. Medical history, use and respons e to chemotherapy and brachytherapy, operative records, renal function, pat hological results, survival, and techniques for partial and repeat nephrect omy and brachytherapy were reviewed. Results: We treated 8 boys and 15 girls, of whom 21 who presented with sync hronous bilateral Wilms tumor underwent primary chemotherapy followed by se condary partial nephrectomy. A total of 44 partial nephrectomies were perfo rmed and brachytherapy was done in 7 patients. Ten children have normal ren al function and no disease, 10 are dead and 2 have metastatic disease. Anap lasia was the most significant factor associated with an unfavorable outcom e (p = 0.003). Of the patients who were cured 60% had a positive response t o initial chemotherapy compared with only 25% who had an unfavorable outcom e (p = 0.09). No significant differences were noted with respect to gender, age at presentation, highest local tumor stage at presentation or initial nephrectomy. No patient treated with brachytherapy had local recurrence. Conclusions: Preoperative chemotherapy followed by nephron sparing surgery is indicated in patients with bilateral Wilms tumor, while in those with di ffuse anaplasia nephron sparing surgery is contraindicated. Brachytherapy s hould be considered for treating local disease involving chemoresistant tum ors.