Re: Results of novel strategies for treatment of Wilms' tumor

LETTER TO THE EDITOR

Division of Urology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil

Int Braz J Urol, 33: 195–203, 2007

To the Editor:

Multimodality treatment, including chemotherapy, has resulted in a significant improvement in the survival of children with Wilms' tumor (WT), from approximately 30% in the 1930s to more than 85% in the modern era (1). This excellent work by Tucci and associates shows the results of treatment of 53 children with WT, that were treated according to protocols of the Brazilian Wilms' Tumor Study Group, exception made to16 cases with stage I tumor, who received a short duration postoperative treatment with vincristine. This group of patients showed a disease–free survival rate of 100% in a median time of 101 months. On the other hand, the overall and disease–free survival of 10 patients with recurrent WT at 5 years was only 42.8%.

The results of this report are comparable to others in the literature, that support the use of less–aggressive adjuvant chemotherapy for patients with low stage disease (1,2) . As most children in this group had favorable histology, no conclusion can be obtained regarding the influence of this important aspect, since favorable histology seems to be another factor that enables stratification of patients for a reduced chemotherapy in all stages of the disease, including stage–1 (2).

The authors also describe unsuccessful results of re–treatment of children who relapse after initial treatment. More recent works, however, show a significant improvement of long term survival (up to 60%) in such patients who are treated with intensive–dose salvage chemotherapy regimes including ifosfamide, carboplatin and etoposide, as well as autologous hematopoietic stem–cell rescue (3).

Further improvement in adjuvant therapy regimes can also be obtained by neoadjuvant chemotherapy, that concomitantly enables a technically easier and safer surgical removal of the tumor, without the risks and hazards of tumor spilage (4,5).

The aim of clinical trials nowadays is to reduce chemotherapy for children with low–risk tumors, therefore reducing its side effects, and to improve it in patients with high–risk Wilms' tumor, including those with anaplastic, bilateral and recurrent tumors (1,6).

References

1. Spreafico F, Bellani FF: Wilms' tumor: past, present and (possibly) future. Expert Rev Anticancer Ther. 2006; 6: 249–58.

2. Dome JS, Cotton CA, Perlman EJ, Breslow NE, Kalapurakal JA, Ritchey ML, et al.: Treatment of anaplastic histology Wilms' tumor: results from the fifth National Wilms' Tumor Study. J Clin Oncol. 2006; 24: 2352–8.

3. Green DM, Cotton CA, Malogolowkin M, Breslow NE, Perlman E, Miser J, et al.: Treatment of Wilms tumor relapsing after initial treatment with vincristine and actinomycin D: a report from the National Wilms Tumor Study Group. Pediatr Blood Cancer. 2007; 48: 493–9.

4. Duarte RJ, Denes FT, Cristofani LM, Odone–Filho V, Srougi M: Further experience with laparoscopic nephrectomy for Wilms' tumor after chemotherapy. BJU Int. 2006; 98: 155–9.

5. Mitchell C, Pritchard–Jones K, Shannon R, Hutton C, Stevens S, Machin D, et al.: Immediate nephrectomy versus preoperative chemotherapy in the management of non–metastatic Wilms' tumour: results of a randomised trial (UKW3) by the UK Children's Cancer Study Group. Eur J Cancer. 2006; 42: 2554–62.

6. Gommersall LM, Arya M, Mushtaq I, Duffy P: Current challenges in Wilms' tumor management. Nat Clin Pract Oncol. 2005; 2: 298–304.

Dr. F. Tibor Denes

Division of Urology

University of Sao Paulo Medical School

Sao Paulo, SP, Brazil

E–mail: [e-mail]

Re: Results of novel strategies for treatment of Wilms' tumor

Silvio Tucci Jr; Adauto J. Cologna; Haylton J. Suaid; Elvis T. Valera; Luis F. Tirapelli; Edson L. Paschoalin; Antonio C. Martins

Publication Dates

• Publication in this collection
  29 Aug 2007
• Date of issue
  June 2007