The use of preoperative chemotherapy in Wilms' tumor with contained retroperitoneal rupture

Purpose: The National Wilms Tumor Study currently describes 3 indications for the use of preoperative chemotherapy: extensive caval involvement, bilateral tumors, and patients who only have a single kidney. However, the management of patients who present with a contained retroperitoneal rupture isnottamination when specifically addressed. This is relevant because of the strong possibility of peritoneal con performing a primary resection and the resultant requirement for total abdominal radiation. The use of neoadjuvant chemotherapy in this subgroup of patients may be warranted. Methods: We retrospectively reviewed our experience with Wilms' tumor and identified 3 cases with contained rupture at presentation. Details of their initial evaluation and therapy, resection and pathologic-up constitute this report. Institutional review board waiver was obtained for the findings, and follow purposes of this review. Results: Two male patients, aged 2.9 years, and 1 female patient, aged 9.3 years, were identified. All Results: Two patients received preoperative chemotherapy with vincristine and dactinomycin (n = 1) plus doxorubicin (n = 2) for 4 to 6 weeks before surgical resection. One patient underwent pretreatment computed tomography-guided biopsy of the kidney mass for diagnostic purposes. Presurgical computed tomographic scans showed resolution of perinephric blood and fluid with tumor shrinkage. Histopathologic analyses showed all tumors were resected with negative margins, and there was no intraoperative tumor spillage. All patients received 1050 to 1090 cGy of flank radiation postoperatively. All patients are currently alive at follow-up without evidence of local recurrence or distant disease. Conclusions: Neoadjuvant chemotherapy allowed for complete resection and avoidance of total abdominal radiation in 3 patients with ruptured Wilms' tumor and hematoma within the retroperitoneum. These data support the use of initial chemotherapy in children with retroperitoneal rupture and hematoma of Wilms' tumor at diagnosis. (c) 2007 Elsevier Inc. All rights reserved.