Broecker B H, Perlmutter A D
Urology. 1984 Aug;24(2):170-4. doi: 10.1016/0090-4295(84)90421-7.
Wilms tumor has become a model of highly curable cancer. With the addition and refinement of chemotherapy protocols, survival rates have risen from 20 per cent three decades ago to 80 per cent or greater in the past decade. Surgery remains an integral part of the management of Wilms tumor both as a diagnostic tool and for removal of tumor bulk. Few primary tumors cannot be surgically removed during the initial phase of therapy. However, bilateral Wilms tumor and large unilateral tumors may occasionally be initially unresectable without prohibitive loss of renal or nonrenal organ function. The National Wilms Tumor Study group has no protocol for management of these tumors but does offer guidelines unsupported by large numbers of patients. Two cases are presented in which the tumors were initially deemed surgically unresectable. Initial management with chemotherapy (both cases) and radiotherapy (1 case) followed by surgical removal of tumor left both patients free of gross tumor, with relapse-free survivals of two and one-half years and six years thus far. Based on our experience and that found in the literature, we believe that preoperative chemotherapy is indicated for children suspected of having Wilms tumors judged surgically unresectable.
肾母细胞瘤已成为高度可治愈癌症的一个典范。随着化疗方案的增加和完善，生存率已从三十年前的20%上升到过去十年的80%或更高。手术仍然是肾母细胞瘤治疗不可或缺的一部分，既是一种诊断工具，也是用于切除大部分肿瘤。在治疗初始阶段，很少有原发性肿瘤不能通过手术切除。然而，双侧肾母细胞瘤和大型单侧肿瘤偶尔在初始阶段可能无法切除，除非肾脏或非肾脏器官功能有严重损失。国家肾母细胞瘤研究组没有针对这些肿瘤的治疗方案，但确实提供了一些没有大量患者数据支持的指导原则。本文介绍了两例肿瘤最初被认为无法手术切除的病例。最初采用化疗（两例均如此）和放疗（1例），随后手术切除肿瘤，两名患者均无肉眼可见肿瘤，迄今为止无瘤生存率分别为两年半和六年。基于我们的经验以及文献中的发现，我们认为对于怀疑患有经判断无法手术切除的肾母细胞瘤的儿童，术前化疗是必要的。
