Study offers hope for children with kidney tumors

Children with bilateral Wilms’ tumors can retain normal function in both kidneys by undergoing bilateral nephron-sparing surgery, even when preoperative scans suggest that the tumors are inoperable, report researchers at St. Jude Children’s Research Hospital, Memphis, TN.

Between 1999 and 2006, all St. Jude patients with bilateral Wilms’ tumor exhibiting favorable histology underwent bilateral nephron-sparing surgeries. In all 10 instances where the procedure was used, the surgery was successful, often despite preoperative imaging studies suggesting that kidney preservation might not be possible, researchers reported in Cancer (published online March 24, 2008, ahead of print).

“Many times, physicians will look at a child’s scans and assume that it is impossible to remove the tumor while preserving some uninvolved kidney, but our study indicates that surgeons should not rely solely on the imaging to make that decision,” said senior author Andrew Davidoff, MD. “In most cases, the surgeon will be able to save normal kidney on both sides. The study indicates that, when combined with chemotherapy and radiation therapy, this surgical approach provides an opportunity to preserve renal function while maintaining a high probability of cure.”

Since 1999, St. Jude patients whose bilateral Wilms’ tumor exhibited favorable histology have received chemotherapy followed by bilateral partial nephrectomy within 12 weeks of initiation of chemotherapy. Patients in the retrospective study ranged in age from 5 months to 9 years old and were generally referred to St. Jude because of poor response to therapy or unfavorable anatomy. Many of the children received radiation after undergoing surgery.

All patients who exhibited favorable histology Wilms’ tumor are still alive at a mean of nearly 4 years after initial surgery. Nine of the patients exhibited normal renal function at their most recent follow-up exams.