Paulino A C, Wilimas J, Marina N, Jones D, Kumar M, Greenwald C, Chen G, Kun L E
Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
Int J Radiat Oncol Biol Phys. 1996 Oct 1;36(3):541-8. doi: 10.1016/s0360-3016(96)00377-x.
To evaluate the role of radiation therapy (RT), chemotherapy (CT), and surgery in the local control of synchronous bilateral Wilms Tumor (WT).
Between 1962 to 1993, 45 children were treated for bilateral WT; 38 patients with synchronous tumors were reviewed. Initial surgery depended on the era of treatment and included unilateral nephrectomy (N)/partial nephrectomy (PN) and contralateral PN in 6, unilateral N/PN alone in 7, and biopsy only in 25. Chemotherapy (CT) consisted of vincristine, actinomycin-D, and adriamycin in 32 and vincristine/ actinomycin-D in 6. Radiation therapy (RT) was given to 32 patients. Treatment included both kidneys in 20, unilateral kidney plus contralateral renal bed in 9, unilateral kidney in 2, and unilateral renal bed in 1. Follow-up was 16 months to 25 years (median: 6.3 years).
Local control (LC) has been maintained in 66 out of 76 sites (87%). For Stage I-II disease with initial N/PN, LC was 10 out of 12 with RT and 11 out of 11 without RT; for Stage III with initial N/PN, LC was 8 out of 9 with RT and 1 out of 1 without RT. Initial CT and RT was followed by delayed N/PN for 20 sites; LC was 15 out of 17 in post induction Stage I-II and 1 out of 3 in postinduction Stage III. In 23 sites undergoing biopsy and chemotherapy, LC was 19 out of 20 with RT and 1 out of 3 without RT. Seven of 23 sites had a complete response (CR) after induction CT, and LC was maintained in four out of four with RT and one out of three without RT. Univariate Cox Regression analysis demonstrated that sites receiving two drugs had a statistically significant increase in loco-regional relapse when compared to sites receiving three drugs (p = 0.004). Major morbidities related to multimodality therapy have included renal failure in one patient and small bowel obstruction requiring lysis of adhesions in two patients.
Local control does not seem to be compromised by renal conservation therapy. Local control is excellent in sites treated with radiation therapy in combination with three drug chemotherapy.
评估放射治疗（RT）、化疗（CT）和手术在同步双侧肾母细胞瘤（WT）局部控制中的作用。
1962年至1993年间，45例儿童接受了双侧WT治疗；对38例同步肿瘤患者进行了回顾性分析。初始手术取决于治疗时代，包括6例患者行单侧肾切除术（N）/部分肾切除术（PN）及对侧PN，7例患者仅行单侧N/PN，25例患者仅行活检。32例患者接受的化疗（CT）方案为长春新碱、放线菌素-D和阿霉素，6例患者接受长春新碱/放线菌素-D方案。32例患者接受了放射治疗（RT）。20例患者的治疗涉及双侧肾脏，9例患者的治疗涉及单侧肾脏加对侧肾床，2例患者的治疗涉及单侧肾脏，1例患者的治疗涉及单侧肾床。随访时间为16个月至25年（中位时间：6.3年）。
76个部位中有66个（87%）维持了局部控制（LC）。对于初始行N/PN的I-II期疾病，接受RT的12个部位中有10个实现了LC，未接受RT的11个部位中有11个实现了LC；对于初始行N/PN的III期疾病，接受RT的9个部位中有8个实现了LC，未接受RT的1个部位中有1个实现了LC。初始CT和RT后，20个部位随后进行了延迟N/PN；诱导后I-II期的17个部位中有15个实现了LC，诱导后III期的3个部位中有1个实现了LC。在23个接受活检和化疗的部位中，接受RT的20个部位中有19个实现了LC，未接受RT的3个部位中有1个实现了LC。23个部位中有7个在诱导CT后达到完全缓解（CR），接受RT的4个部位中有4个维持了LC，未接受RT的3个部位中有1个维持了LC。单因素Cox回归分析表明，与接受三种药物治疗的部位相比，接受两种药物治疗的部位局部区域复发有统计学意义的增加（p = 0.004）。与多模式治疗相关的主要并发症包括1例患者出现肾衰竭，2例患者出现小肠梗阻需要松解粘连。
肾脏保留治疗似乎不会影响局部控制。放射治疗联合三种药物化疗的部位局部控制效果极佳。
