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| |  Surgical Procedure May Help Children With Wilms' Tumour NEW YORK -- March 25, 2008 -- Physicians at St. Jude Children's Research Hospital, Memphis, Tennessee, have demonstrated that children with bilateral Wilms' tumour can retain normal function in both kidneys by undergoing bilateral nephron-sparing surgery, even when preoperative scans suggest that the tumours are inoperable. Their findings will appear in the advanced online publication of Cancer. Between 1999 and 2006, all patients at St. Jude Children's Research Hospital with bilateral Wilms' tumour who exhibited favourable histology underwent bilateral nephron-sparing surgeries. In every instance when the procedure was used (N = 10), the surgery was successful, often despite preoperative imaging studies that suggested kidney preservation might not be possible. Since 1999, patients at St. Jude Children's Research Hospital whose bilateral Wilms' tumour exhibited favourable histology have received chemotherapy, consisting of vincristine, dactinomycin, and doxorubicin, followed by bilateral partial nephrectomies within 12 weeks of chemotherapy initiation. Patients in the retrospective study were aged 5 months to 9 years, and they were generally referred to the research hospital because of poor response to therapy or unfavourable anatomy. Many of the children received radiation after undergoing surgery. "Many times, physicians will look at a child's scans and assume that it is impossible to remove the tumour 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, Division Chief, General Pediatric Surgery, St. Jude Children's Research Hospital. "In most cases, the surgeon will be able to save normal kidney on both sides," Dr. Davidoff said. "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." According to Dr. Davidoff, nephron-sparing surgery is a more complex procedure than a complete nephrectomy. "Commonly, when a child has bilateral disease, the surgeon will remove the kidney that has the most tumour and do a partial nephrectomy on the other side," he said. "But if a patient then develops problems in the remaining kidney, the options are limited because one kidney has been taken out of the equation. At St. Jude [Children's Research Hospital], we try to save as much kidney as possible in children with bilateral disease. Thus far, 100% of the time we have been able to save normal kidney on both sides." All patients who exhibited favourable histology of Wilms' tumour are still alive, with an average of nearly 4 years after initial surgery. Nine of the patients exhibited normal renal function at their most recent follow-up exams. This study was supported by a US Public Health Service Childhood Solid Tumor Program grant, a Cancer Center Support Grant from the US National Cancer Institute, Bethesda, Maryland, and the American Lebanese Syrian Associated Charities, Memphis, Tennessee. SOURCE: St. Jude Children's Research Hospital, Memphis, Tennessee.
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