Rutigliano Daniel N, Kayton Mark L, Steinherz Peter, Wolden Suzanne, La Quaglia Michael P
Division of Pediatric Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
J Pediatr Surg. 2007 Sep;42(9):1595-9. doi: 10.1016/j.jpedsurg.2007.04.036.
The National Wilms Tumor Study currently describes 3 indications for the use of preoperative chemotherapy: extensive caval involvement, bilateral tumors, and patients who only have a single kidney. However, the management of patients who present with a contained retroperitoneal rupture is not specifically addressed. This is relevant because of the strong possibility of peritoneal contamination when performing a primary resection and the resultant requirement for total abdominal radiation. The use of neoadjuvant chemotherapy in this subgroup of patients may be warranted.
We retrospectively reviewed our experience with Wilms' tumor and identified 3 cases with contained rupture at presentation. Details of their initial evaluation and therapy, resection and pathologic findings, and follow-up constitute this report. Institutional review board waiver was obtained for the purposes of this review.
Two male patients, aged 2.9 years, and 1 female patient, aged 9.3 years, were identified. All patients received preoperative chemotherapy with vincristine and dactinomycin (n = 1) plus doxorubicin (n = 2) for 4 to 6 weeks before surgical resection. One patient underwent pretreatment computed tomography-guided biopsy of the kidney mass for diagnostic purposes. Presurgical computed tomographic scans showed resolution of perinephric blood and fluid with tumor shrinkage. Histopathologic analyses showed all tumors were resected with negative margins, and there was no intraoperative tumor spillage. All patients received 1050 to 1080 cGy of flank radiation postoperatively. All patients are currently alive at follow-up without evidence of local recurrence or distant disease.
Neoadjuvant chemotherapy allowed for complete resection and avoidance of total abdominal radiation in 3 patients with ruptured Wilms' tumor and hematoma within the retroperitoneum. These data support the use of initial chemotherapy in children with retroperitoneal rupture and hematoma of Wilms' tumor at diagnosis.
国家肾母细胞瘤研究目前描述了术前化疗的3个适应证：腔静脉广泛受累、双侧肿瘤以及仅有一个肾脏的患者。然而，对于出现局限性腹膜后破裂的患者的管理并未具体涉及。这很重要，因为在进行初次切除时腹膜污染的可能性很大，以及由此产生的全腹放疗需求。在这一亚组患者中使用新辅助化疗可能是必要的。
我们回顾性分析了我们治疗肾母细胞瘤的经验，确定了3例初诊时存在局限性破裂的病例。本报告包括他们的初始评估和治疗、切除及病理结果以及随访的详细情况。为进行本综述，已获得机构审查委员会的豁免。
确定了2例男性患者，年龄分别为2.9岁和1例9.3岁的女性患者。所有患者在手术切除前接受了4至6周的术前化疗，使用长春新碱和放线菌素D（n = 1）加阿霉素（n = 2）。1例患者为诊断目的在术前接受了计算机断层扫描引导下的肾脏肿块活检。术前计算机断层扫描显示肾周血液和液体消退，肿瘤缩小。组织病理学分析显示所有肿瘤均切除，切缘阴性，术中无肿瘤溢出。所有患者术后接受了1050至1080 cGy的侧腹放疗。所有患者目前在随访中均存活，无局部复发或远处疾病的证据。
新辅助化疗使3例肾母细胞瘤破裂并伴有腹膜后血肿的患者得以完全切除，并避免了全腹放疗。这些数据支持在诊断为肾母细胞瘤伴有腹膜后破裂和血肿的儿童中使用初始化疗。
