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Inoperable Tumors
Treatment Options
Treatment Options
Patients who have tumors with caval extension above the hepatic veins or that
are so massive that their surgeons consider the risk of initial surgical
removal too great should be biopsied and treated with preoperative
chemotherapy.[1,2] If surgery is performed on a patient with caval or atrial
extension, care should be taken to ensure that appropriate resources are
available for pediatric cardiopulmonary bypass.[3,4] On the National Wilms Tumor Study-5 (NWTS-5), these
patients are treated after biopsy by initial chemotherapy with vincristine
and dactinomycin with or without doxorubicin. If no reduction in tumor size
has occurred after using three drugs, then radiation therapy should be used.[5]
Surgery is performed as soon as sufficient tumor shrinkage has occurred,
generally at week 6 of therapy. If resection of the tumor cannot occur at this time, the patient should undergo a second-look procedure to confirm a persistent tumor. Failure of the tumor to shrink could be a result of a predominance of skeletal or benign elements. Patients are subsequently treated as
for stage III tumors, which includes postoperative radiation therapy.[6] Because of the 5% to 10% error rate in preoperative diagnosis of renal masses
after radiographic assessment, confirmation of the diagnosis by biopsy (which
may be performed percutaneously) should be obtained prior to chemotherapy.[1]
References
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Ritchey ML: The role of preoperative chemotherapy for Wilms' tumor: the NWTSG perspective. National Wilms' Tumor Study Group. Semin Urol Oncol 17 (1): 21-7, 1999.
[PUBMED Abstract]
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Shamberger RC, Ritchey ML, Haase GM, et al.: Intravascular extension of Wilms tumor. Ann Surg 234 (1): 116-21, 2001.
[PUBMED Abstract]
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Thompson WR, Newman K, Seibel N, et al.: A strategy for resection of Wilms' tumor with vena cava or atrial extension. J Pediatr Surg 27 (7): 912-5, 1992.
[PUBMED Abstract]
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Ritchey ML, Kelalis PP, Haase GM, et al.: Preoperative therapy for intracaval and atrial extension of Wilms tumor. Cancer 71 (12): 4104-10, 1993.
[PUBMED Abstract]
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Green DM, Breslow NE, Evans I, et al.: The effect of chemotherapy dose intensity on the hematological toxicity of the treatment for Wilms' tumor. A report from the National Wilms' Tumor Study. Am J Pediatr Hematol Oncol 16 (3): 207-12, 1994.
[PUBMED Abstract]
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Tournade MF, Com-Nougué C, Voûte PA, et al.: Results of the Sixth International Society of Pediatric Oncology Wilms' Tumor Trial and Study: a risk-adapted therapeutic approach in Wilms' tumor. J Clin Oncol 11 (6): 1014-23, 1993.
[PUBMED Abstract]
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