Produção Nacional
Revisado por pares
Results of novel strategies for treatment of Wilms' tumor
2007; Sociedade Brasileira de Urologia; Volume: 33; Issue: 2 Linguagem: Inglês
10.1590/s1677-55382007000200011
ISSN1677-6119
AutoresSílvio Tucci, Adauto José Cologna, Haylton Jorge Suaid, Elvis Terci Valera, Luís Fernando Tirapelli, Edson Luis Paschoalin, Antônio Carlos Pereira Martins,
Tópico(s)Renal and related cancers
ResumoTo evaluate treatment outcomes in Wilms' tumor (WT).We studied 53 children with median age of 2 years with WT, stages I-19, II-14, III-12, IV-6 and V-2. Treatment consisted of surgical excision plus adjuvant (40 children) or neoadjuvant and adjuvant chemotherapy (unresectable tumor, n=8, or caval tumor extension, n=5). Chemotherapy and radiotherapy followed protocols of Brazilian Wilms' Tumor Study Group excepting 16 cases with stage I disease that received a short duration postoperative treatment with vincristine (VCR - 11 doses) and dactinomycin (AMD - 4 doses). Relapsed WT was treated with multiagent regimens including cisplatin/carboplatin, cyclophosphamide, ifosfamide and etoposide. One patient with resistant relapsed WT was treated by high-dose conditioning chemotherapy with stem cell rescue.Overall and disease-free survival rates at 5 years were respectively 88.2 +/- 5.0% and 76.7 +/- 6.6%. Short duration therapy for stage I tumor showed a disease-free survival rate of 100% in a median time of 101 months (range 14 to 248 months). Overall and disease-free survival of 10 patients with recurrent WT at 5 years was 42.8%. The child treated with high-dose chemotherapy plus stem cell transplant is alive without evidence of disease 84 months from relapse.The postoperative chemotherapy in stage I disease can be reduced without compromising the cure rate. The treatment of unfavorable stage III and IV disease or relapsed tumor remains a challenge.
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