| RE:
RESULTS OF NOVEL STRATEGIES FOR TREATMENT OF WILMS’ TUMOR
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SILVIO TUCCI JR,
ADAUTO J. COLOGNA, HAYLTON J. SUAID, ELVIS T. VALERA, LUIS F. TIRAPELLI,
EDSON L. PASCHOALIN, ANTONIO C. MARTINS
Division
of Urology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao
Preto, Sao Paulo, Brazil
Int
Braz J Urol, 33: 195-203, 2007
To the Editor:
Multimodality
treatment, including chemotherapy, has resulted in a significant improvement
in the survival of children with Wilms’ tumor (WT), from approximately
30% in the 1930s to more than 85% in the modern era (1). This excellent
work by Tucci and associates shows the results of treatment of 53 children
with WT, that were treated according to protocols of the Brazilian Wilms’
Tumor Study Group, exception made to16 cases with stage I tumor, who received
a short duration postoperative treatment with vincristine. This group
of patients showed a disease-free survival rate of 100% in a median time
of 101 months. On the other hand, the overall and disease-free survival
of 10 patients with recurrent WT at 5 years was only 42.8%.
The results of this report are comparable
to others in the literature, that support the use of less-aggressive adjuvant
chemotherapy for patients with low stage disease (1,2) . As most children
in this group had favorable histology, no conclusion can be obtained regarding
the influence of this important aspect, since favorable histology seems
to be another factor that enables stratification of patients for a reduced
chemotherapy in all stages of the disease, including stage-1 (2).
The authors also describe unsuccessful results
of re-treatment of children who relapse after initial treatment. More
recent works, however, show a significant improvement of long term survival
(up to 60%) in such patients who are treated with intensive-dose salvage
chemotherapy regimes including ifosfamide, carboplatin and etoposide,
as well as autologous hematopoietic stem-cell rescue (3).
Further improvement in adjuvant therapy
regimes can also be obtained by neoadjuvant chemotherapy, that concomitantly
enables a technically easier and safer surgical removal of the tumor,
without the risks and hazards of tumor spilage (4,5).
The aim of clinical trials nowadays is to
reduce chemotherapy for children with low-risk tumors, therefore reducing
its side effects, and to improve it in patients with high-risk Wilms’
tumor, including those with anaplastic, bilateral and recurrent tumors
(1,6).
References
1. Spreafico F, Bellani FF: Wilms’ tumor: past, present and (possibly)
future. Expert Rev Anticancer Ther. 2006; 6: 249-58.
2. Dome JS, Cotton CA, Perlman EJ, Breslow NE, Kalapurakal JA, Ritchey
ML, et al.: Treatment of anaplastic histology Wilms’ tumor: results
from the fifth National Wilms’ Tumor Study. J Clin Oncol. 2006;
24: 2352-8.
3. Green DM, Cotton CA, Malogolowkin M, Breslow NE, Perlman E, Miser J,
et al.: Treatment of Wilms tumor relapsing after initial treatment with
vincristine and actinomycin D: a report from the National Wilms Tumor
Study Group. Pediatr Blood Cancer. 2007; 48: 493-9.
4. Duarte RJ, Denes FT, Cristofani LM, Odone-Filho V, Srougi M: Further
experience with laparoscopic nephrectomy for Wilms’ tumor after
chemotherapy. BJU Int. 2006; 98: 155-9.
5. Mitchell C, Pritchard-Jones K, Shannon R, Hutton C, Stevens S, Machin
D, et al.: Immediate nephrectomy versus preoperative chemotherapy in the
management of non-metastatic Wilms’ tumour: results of a randomised
trial (UKW3) by the UK Children’s Cancer Study Group. Eur J Cancer.
2006; 42: 2554-62.
6. Gommersall LM, Arya M, Mushtaq I, Duffy P: Current challenges in Wilms’
tumor management. Nat Clin Pract Oncol. 2005; 2: 298-304.
Dr.
F. Tibor Denes
Division of Urology
University of Sao Paulo Medical School
Sao Paulo, SP, Brazil
E-mail: f.c.denes@br2001.com.br
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