Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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5-Year Impact Factor – 2.135
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2012, vol. 21, nr 6, November-December, p. 809–820

Publication type: review article

Language: English

Advances and Changes in the Treatment of Children with Nephroblastoma

Postęp i zmiany w leczeniu nerczaka płodowego u dzieci

Wojciech Pietras1,

1 Department and Clinic of Pediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Poland

Abstract

Wilms’ tumor or nephroblastoma is the most common malignant tumor stemming from kidney cells and second only to neuroblastoma when it comes to extracranial solid tumors in children. The results of nephroblastoma treatment are a perfect example of therapeutic success resulting from an interdisciplinary approach to the problem and the cooperation of pediatric surgeons, pediatric oncologists, pathologists, radiologists and radiotherapists leading to precise diagnoses and the selection of the optimal treatment. At the end of the sixties, international research teams began studying the best treatment for this tumor in children. In Europe, it was the International Society of Paediatric Oncology (SIOP), which has used the working name SIOP – RTSG (Renal Tumor Study Group – Group for the Study of Kidney tumors) since 2008 and in North America NWTS (National Wilms’ Tumor Study – The National Committee for Research on Wilms’ tumor). Summarizing the experience and knowledge on the treatment of nephroblastoma, it should be noted that, despite years of research and information exchange, uniform guidelines have not yet been developed, and there are still differences in treatment of this tumor. The biggest differences are between the “American” treatment recommended by the NWTS and the “European” by SIOP. In the first it is recommended to start treatment from the surgical removal of the tumor, even in the case of disseminated disease with the presence of metastases in the lungs. The treatment method is chosen by the institution managing the patient; for this reason on the American continent in Brazil, Wilms’ tumor is treated according to the recommendations of “European” protocols (SIOP) and some institutions in Europe, for example in Italy, treat patients with nephroblastoma according to the “American” protocols recommended by the NWTS; until recently, focal disease was treated with primary nephrectomy in the UK.

Streszczenie

Nerczak płodowy (zarodkowy) (nephroblastoma) – guz Wilmsa – jest najczęstszym nowotworem złośliwym wychodzącym z nerek, drugim po nerwiaku zarodkowym pozaczaszkowym, guzem litym u dzieci. Wyniki leczenia nerczaka zarodkowego są modelowym przykładem sukcesu leczniczego wynikającego z interdyscyplinarnego podejścia do problemu i wspólnego działania chirurgów dziecięcych, onkologów dziecięcych, patologów, radiologów i radioterapeutów, co doprowadziło do precyzyjnego rozpoznawania i wyboru optymalnego sposobu leczenia. Pod koniec lat 60. XX w. rozpoczęły się prace badawcze nad wyborem optymalnego sposobu leczenia tego guza u dzieci przez międzynarodowe zespoły badawcze. W Europie był to SIOP (Międzynarodowe Towarzystwo Pediatrów Onkologów), które od 2008 r. używa roboczej nazwy SIOP RTSG (Renal Tumor Study Group), w Ameryce Północnej NWTS (National Wilms’ Tumor Study). Podsumowując dotychczasowe doświadczenia w leczeniu nerczaka zarodkowego, należy zwrócić uwagę, iż mimo wieloletnich badań i wymiany informacji nie wypracowano jednolitego postępowania i istnieją w dalszym ciągu różnice w sposobach leczenia tego guza. Największe różnice pozostają między sposobem leczenia „amerykańskim” rekomendowanym przez NWTS a „europejskim” przez SIOP. W pierwszym jest zalecane rozpoczęcie leczenia od chirurgicznego usunięcia guza, nawet w chorobie rozsianej z obecnością przerzutów w płucach. O wyborze sposobu terapii decyduje ośrodek leczący, stąd też np. na kontynencie amerykańskim, w Brazylii guz Wilmsa leczy się wg zaleceń „europejskich” – protokołów SIOP, a w Europie, np. we Włoszech, część ośrodków leczy wg protokołów „amerykańskich” rekomendowanych przez NWTS. Do niedawna w postaciach umiejscowionych pierwotną nefrektomię wykonywano w Wielkiej Brytanii.

Key words

nephroblastoma, Wilms’ tumor, treatment

Słowa kluczowe

nerczak płodowy, guz Wilmsa, leczenie

References (39)

  1. D’Angio GJ: Preor postoperative therapy for Wilms’ tumor? J Clin Oncol 2008, 26(25), 4055–4057.
  2. D’Angio GJ, Evans AE, Breslow NE et al.: The treatment of Wilms Tumor: results of the National Wilms Tumor Study. Cancer 1976, 38, 633–646.
  3. D’Angio GJ, Evans A, Breslow N et al.: The treatment of Wilms tumor: results of the Second National Wilms Tumor Study. Cancer 1981, 47, 2302–2311.
  4. D’Angio GJ, Breslow NE, Beskwith JB et al.: Treatment of Wilms Tumor: results of Third National Wilms Tumor Study. Cancer 1989, 64, 349–360.
  5. Bailey S, Roberts A, Brock C et al.: Nephrotoxicity in survivors of Wilms’ tumours in the North of England. Br J Cancer 2002, 87(10), 1092–1098.
  6. Beckwith JB, Palmer NF: Histopathology and prognosis of Wilms’ tumor. Results from the first National Wilms’ Tumor Study. Cancer 1978, 41, 1937–1948.
  7. Boccon-Gibod L, Rey A, Sandstedt B et al.: Complete necrosis induced by preoperative chemotherapy in Wilms tumor as an indicator of low risk: Report of the International Society of Pediatric Oncology (SIOP) Nephroblastoma Trial and Study 9. Med Pediatr Oncol 2000, 34, 183–190.
  8. Breslow NE, Olsham A, Beckwith JB et al.: Epidemiology of Wilms Tumor. Med Ped Oncol 1993, 21, 172–181.
  9. Breslow NE, Sharples K, Beckwith JB et al.: Prognostic factors in nonmetastatic, favorable histology Wilms’ tumor. Results of the Third National Wilms’ Tumor Study. Cancer 1991, 68, 2345–2353.
  10. Cozzi DA, Schiavetti A, Morini F et al.: Nephron sparing surgery for unilateral primary renal tumor in children. J Pediatr Surg 2001, 36, 2, 362–365.
  11. Davidoff AM, Giel DW, Jones DP et al.: The feasibility and outcome of nephron-sparing surgery for children with bilateral Wilms’ tumor. The St. Jude Children’s Research Hospital experience: 1999–2006. Cancer 2008, 1, 112, 2060–2070.
  12. Delemarre JFM, Rey A, Harms D et al.: The epithelial type of nephroblastoma to be considered as a nephroblastoma with favourable histology? Med Pediatr Oncol 1992, 20, 435.
  13. Diller L, Ghahremani M, Morgan J et al.: Consitutional WT1 Mutations in Wilms’ Tumor Patients. J Clin Oncol 1998, 16(11), 3634–3640.
  14. Dome JS, Cotton CA, Perlman EJ et al.: Treatment of Anaplastic Histology Wilms’ Tumor: Results From the Fifth National Wilms’ Tumor Study. J Clin Oncol 2006, 24(15), 2352–2358.
  15. Graf N, Tournade MF, de Kraker J: The role of preoperative chemotherapy in the management of Wilms tumor. The SIOP studies. International Society of Pediatric Oncology. Urol Clin North Am 2000, 27, 443–454.
  16. Green DM, Breslow N, Beckwith B et al.: Effect of duration of treatment on treatment outcome and cost of treatment for Wilms tumor: a report from the National Wilms Tumor Study Group. J Clin Oncol 1998, 16, 3744–3751.
  17. Green DM, Breslow N, Beckwith B et al.: Treatment with nephrectomy only for small, stage I/favorable histology Wilms’ tumor: a report from the National Wilms Tumor Study Group. J Clin Oncol 2001, 19, 3719–3724.
  18. Green DM, Yevgeny A, Grigoriev J et al.: Congestive Heart Failure After Treatment for Wilms` Tumor: A report from The National Wilms` Tumor Study Group. J Clin Oncol 19, 2001, 1926–1934.
  19. Gross RE: The surgery of infancy and childhood. Philadelphia: WB Saunders Co., 1953.
  20. Grundy PE, Coppes M: An overview of the clinical and molecular genetics of Wilms’ tumor. Med Pediatr Oncol 1996, 27, 394–397.
  21. Hartman DJ, MacLennan GT: Wilms tumor. J Urol 2005, 173, 2147–2149.
  22. de Kraker J, Lemerle J, Voute PA et al.: Wilms’ tumour with pulmonary metastases at diagnosis: the significance of primary chemotherapy. J Clin Oncol 1990, 8, 1187–1190.
  23. deKraker J, Tournade MF, Weirich A et al.: Wilms tumour stage IV. A report from the SIOP-9 study. Med Pediatr Oncol 1997, 29, 370.
  24. DeKraker J, Tournade MF, Graf N: The SIOP Nephroblastoma Trials and Studies. A report. Med Pediatr Oncol 1998, 31, 241.
  25. Kremer LC, van der Pal HJ, Offringa M et al.: Frequency and risk factors of subclinical cardiotoxicity after anthracycline therapy in children: a systematic review. Ann Oncol 2002, 13, 819–829.
  26. Lemerle J, Voûte PA, Tournade MF, Delemarre JFM et al.: Preoperative versus postoperative radiotherapy, single versus multiple courses of actinomycin D in the treatment of Wilms’ tumor. Preliminary results of a controlled clinical trial conducted by the International Society of Paediatric Oncology (SIOP). Cancer 1976, 38(2), 647–654.
  27. Lemerle J, Voûte PA, Tournade MF et al.: Effectiveness of preoperative chemotherapy in Wilms’ tumor: results of an International Society of Paediatric Oncology (SIOP) clinical trial. J Clin Oncol 1983, 1(10), 604–609.
  28. Nephroblastoma clinical trial and study SIOP 2001. A therapeutic trial and prospective study protocol. SIOP Nephroblastoma Trial & Study Office, Amsterdam, Netherlands, December, 2001.
  29. Pietras W: Nephroblastoma. In: Od objawu do nowotworu: wczesne rozpoznawanie chorób nowotworowych u dzieci. Ed.: Alicja Chybicka. Elsevier Urban & Partner, Wrocław 2009, 171–175.
  30. Ritchey ML: Renal sparing surgery for Wilms’ tumor. J Urol 2005, 174, 1172–1173.
  31. Sawicz-Birkowska K: Nerczak płodowy. In: Onkologia i hematologia dziecięca. T. 1. Eds.: Alicja Chybicka, Krystyna Sawicz-Birkowska. PZWL, Warszawa 2008.
  32. Sawicz-Birkowska K, Godziński J, Bagłaj M et al.: Wyniki leczenia nerczaków u dzieci według schematu 01-92 Polskiej Grupy do spraw Leczenia Guzów Litych u Dzieci. Pediatr Pol 1996, suppl. 9, 123–127.
  33. Simbre VC, Duffy SA, Dadlani GH et al.: Cardiotoxicity of cancer chemotherapy: implications for children. Paediatr Drugs 2005, 7(3), 187–202.
  34. SIOP Interim Statistical Report; Nephroblastoma Clinical Trial and Study SIOP 2001 from SIOP RTSG Committee meeting 22th/23th November 2009. London, UK.
  35. Sredni ST, Gadd S, Huang CC et al.: Subsets of very low risk Wilms tumor show distinctive gene expression, histologic and clinical features. Clin Cancer Res 2009, 9(12), 6800–6809.
  36. Tournade MF, Com-Nougué C, Voûte PA et al.: Results of the International Society of Pediatric Oncology 6 Wilms’ tumor trial and study: a risk-adapted therapeutic approach in Wilms’ tumor. J Clin Oncol 1993, 11, 1014–1023.
  37. Tournade MF, de Kraker J, Lemerle J et al.: Preoperative chemotherapy of patients over 6 months of age with a nephroblastoma. A report of the SIOP Wilms’ Tumour Trials and Studies. Med Pediatr Oncol 1994, 23, 171.
  38. Tournade MF, Com-Nougue C, De Kraker J et al.: Optimal duration of pre-operative therapy in unilateral and non-metastatic Wilms tumour in children older than 6 months: Results of the ninth International Society of Paediatric Oncology Wilms tumour trial and study. J Clin Oncol 19, 2001, 488–500.
  39. Wright KD, Green DM, Daw NC et al.: Late effects of treatment for Wilms tumor. Pediatr Hematol Oncol 2009, 26(6), 407–413.
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