A case of mixed adult Wilms’ tumour and angiosarcoma responsive to carboplatin, etoposide and vincristine (CEO)

• Published in: Cancer chemotherapy and pharmacology 2008-04, Vol.61 (4), p.717-720
• Main Authors: Yau, Thomas, Leong, C. H., Chan, W. K., Chan, J. K., Liang, R. H. S., Epstein, R. J.
• Format: Article
• Language: English
• Subjects: Adult; Antineoplastic agents; Antineoplastic Agents - administration & dosage; Antineoplastic Agents, Phytogenic - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cancer Research; Carboplatin - administration & dosage; Combined Modality Therapy; Etoposide - administration & dosage; Fatal Outcome; Female; Hemangiosarcoma - drug therapy; Hemangiosarcoma - pathology; Hemangiosarcoma - surgery; Humans; Kidney Neoplasms - drug therapy; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidneys; Magnetic Resonance Imaging; Medical sciences; Medicine; Medicine & Public Health; Neoplasm Metastasis; Neoplasm Recurrence, Local; Nephrology. Urinary tract diseases; Oncology; Pharmacology. Drug treatments; Pharmacology/Toxicology; Platelet Count; Short Communication; Tomography, X-Ray Computed; Tumors of the urinary system; Vincristine - administration & dosage; Wilms Tumor - drug therapy; Wilms Tumor - pathology; Wilms Tumor - surgery
• ISSN: 0344-5704; 1432-0843
• DOI: 10.1007/s00280-007-0529-1

Here we report an unusual case of mixed Wilms’ tumour and angiosarcoma in a 38-year-old female patient who presented with haematuria and right lower back pain. A computed tomographic (CT) scan confirmed a massive renal tumour associated with extensive retroperitoneal lymph node involvement, bony metastases and a right hip fracture. She was initially managed with palliative nephrectomy, which was followed by rapid postoperative deterioration. Histopathology revealed differentiated adult Wilms’ tumour with renal angiosarcoma, whereas the pathology of the para-aortic lymph node and bone metastasis revealed angiosarcoma only. In view of her cachexia and cytopaenia, emergency chemotherapy was initiated using a modified regimen of carboplatin, etoposide and vincristine (CEO) in preference to the more traditional but less well-tolerated VAC (vincristine, actinomycin D, cyclophosphamide). Four cycles of this protocol yielded a dramatic response on re-staging CT scan. This case suggests that highly angiogenic tumours such as angiosarcoma may be effectively palliated using agents usually reserved for refractory Wilms’ tumour, and supports the view that adult Wilms’ tumour is more sensitive to such agents.