The value of surgery in directing therapy for patients with Wilms' tumor with pulmonary disease. A report from the National Wilms' Tumor Study Group (National Wilms' Tumor Study 5)

Computed tomography (CT) of the chest with its increased sensitivity frequently identifies lesions not visible on chest radiograph. Treatment of such lesions is controversial. A recent review suggests that patients with Wilms' tumor with pulmonary lesions detected only by CT, who were treated w...

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Bibliographic Details
Published in:Journal of pediatric surgery 2006, Vol.41 (1), p.162-167
Main Authors: Ehrlich, Peter F., Hamilton, Thomas E., Grundy, Paul, Ritchey, Michael, Haase, Gerald, Shamberger, Robert C.
Format: Article
Language:English
Subjects:
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biopsy
Child
Diagnosis, Differential
Female
Humans
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Lung Diseases - diagnostic imaging
Lung Neoplasms - diagnostic imaging
Lung Neoplasms - secondary
Lung Neoplasms - surgery
Male
Radiography
Radiotherapy
Retrospective Studies
Wilms Tumor - diagnostic imaging
Wilms Tumor - secondary
Wilms Tumor - surgery
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Summary:Computed tomography (CT) of the chest with its increased sensitivity frequently identifies lesions not visible on chest radiograph. Treatment of such lesions is controversial. A recent review suggests that patients with Wilms' tumor with pulmonary lesions detected only by CT, who were treated with dactinomycin and vincristine, have an inferior outcome compared with those who also received pulmonary radiation therapy (RT) and doxorubicin. It is important to determine if these small lesions seen only on CT represent metastatic disease and whether patients with these lesions require RT and/or doxorubicin for optimal outcome. Patients with Wilms' tumor with lung metastasis, registered on National Wilms' Tumor Study 5, were reviewed, and those with CT-only lesions who had a radiology and surgical checklist submitted were identified. The treatment regimens of these patients and the histological findings of the pulmonary lesions are presented. We analyzed the pathological findings by whether the patients had single or multiple lesions. Of 2498 patients registered on National Wilms' Tumor Study 5, 252 had pulmonary metastases. Of these patients, 129 (5.2%) had CT-only lesions (
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2005.10.020