Adv Pediatr Surg.  2022 Dec;28(2):65-69. 10.13029/aps.2022.28.2.65.

Extended Chemotherapy Followed by Staged Bilateral Nephron Sparing Surgery in Advanced Bilateral Wilms Tumor: Individualising Treatment Options for Optimal Outcome

• Karagiri MR
• Malik K
• Radhakrishnan V
• Raja A

• KMID: 2538291
• DOI: http://doi.org/10.13029/aps.2022.28.2.65

Abstract

Approximately 5% of Wilms tumors are bilateral. Multidisciplinary care including surgery, chemotherapy, and radiation has greatly improved the survival rates. With long-term survivorship, treatment should be planned to ensure quality survival. Nephron-sparing surgery (NSS) is now a recommended alternative to bilateral nephrectomy with renal replacement therapy in bilateral Wilms tumors. However, the feasibility of bilateral NSS is dependent on multiple factors like the size, location of the tumor, and response to chemotherapy. In advanced bilateral tumors, a) prolonging preoperative chemotherapy to achieve optimum response for performing a salvageable renal surgery and b) administering chemotherapy in between the staged nephrectomies, is an effective strategy. Response assessment with imaging will help in a) selection of appropriate surgery, b) timing and c) sequencing of surgery. We present a patient with bilateral Wilms tumor managed with neoadjuvant chemotherapy followed by staged bilateral NSS followed by adjuvant chemotherapy at our institute. The patient is alive with a follow-up of 5 years.

Keyword

Wilms tumor; Nephrectomy; Renal insufficiency; Neoadjuvant chemotherapy