Greenberg M, Burnweit C, Filler R, Weitzman S, Sohl H, Chan H, Jenkin D, Dougherty M, Berry M, Balcolm A
Division of Haematology/Oncology, Hospital For Sick Children, Toronto, Ontario, Canada.
J Pediatr Surg. 1991 Aug;26(8):949-53; discussion 953-6. doi: 10.1016/0022-3468(91)90842-h.
Five years ago, the use of preoperative chemotherapy for Wilms' tumor was adopted at this institution. Thirty children ranging in age from 5 months to 9 years had histologically confirmed Wilms' tumor (needle biopsy, n = 26; open biopsy, n = 4). Stage was determined by chest and abdominal computed tomography (CT) scan. Bilateral tumors were present in 6 children. All children received actinomycin D and vincristine from 3 weeks to 6 months before surgery. Seven children with bilateral tumors or stage IV disease also received adriamycin. CT-measured tumor masses shrunk in most cases. Subsequently, nephrectomy was performed in 23 patients and partial nephrectomy in 4, 2 of whom had bilateral disease. In 2 patients, residual bilateral well-differentiated epithelial tumor was not surgically resected. One child died before surgery. Reevaluation at delayed total or partial nephrectomy resulted in a downstaging of disease in 12 (41%). Further chemotherapy and radiation was based on the surgical stage. Postoperative chemotherapy (4 months to 2 years) was administered to all patients. The chest and/or abdomen were radiated in 12. Four patients (13%) died, 1 of radiation pneumonitis and 3 of the disease progression (2 with unfavorable histology, 1 of whom had bilateral disease). Two of 4 with unfavorable histology and 4 of 6 with stage IV disease have survived. It is concluded that this preoperative chemotherapy protocol is as effective as the National Wilms' Tumor Study (NWTS) protocol. The treated tumor is smaller, less friable, and easier to remove. Furthermore, because of downstaging, less radiation is necessary for cure.
五年前，本机构开始采用术前化疗治疗肾母细胞瘤。30名年龄在5个月至9岁之间的儿童经组织学确诊为肾母细胞瘤（26例经针吸活检，4例经开放活检）。通过胸部和腹部计算机断层扫描（CT）确定分期。6名儿童患有双侧肿瘤。所有儿童在手术前3周至6个月接受放线菌素D和长春新碱治疗。7名患有双侧肿瘤或IV期疾病的儿童还接受了阿霉素治疗。大多数情况下，CT测量的肿瘤肿块缩小。随后，23例患者接受了肾切除术，4例接受了部分肾切除术，其中2例患有双侧疾病。2例患者残留的双侧高分化上皮肿瘤未进行手术切除。1名儿童在手术前死亡。延迟进行全肾或部分肾切除术后的重新评估显示，12例（占41%）疾病分期降低。进一步的化疗和放疗根据手术分期进行。所有患者均接受了术后化疗（4个月至2年）。12例患者接受了胸部和/或腹部放疗。4例患者（占13%）死亡，1例死于放射性肺炎，3例死于疾病进展（2例组织学不良，其中1例患有双侧疾病）。4例组织学不良患者中有2例存活，6例IV期疾病患者中有4例存活。结论是，这种术前化疗方案与国家肾母细胞瘤研究（NWTS）方案一样有效。经治疗的肿瘤更小、更不易破碎，且更容易切除。此外，由于分期降低，治愈所需的放疗更少。
