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Nephroblastoma: does the decrease in tumor volume under preoperative chemotherapy predict the lymph nodes status at surgery?
Author(s) -
Godzinski Jan,
van Tinteren Harm,
de Kraker Jan,
Graf Norbert,
Bergeron Christophe,
Heij Hugo,
von Schweinitz Dietrich,
Fuchs Joerg,
Cecchetto Giovanni,
Audry George,
Gauthier Frederic,
Sandstedt Bengt
Publication year - 2011
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.23147
Subject(s) - medicine , nephrectomy , chemotherapy , radiation therapy , interquartile range , urology , lymph , lymph node , wilms' tumor , volume (thermodynamics) , nuclear medicine , surgery , pathology , kidney , physics , quantum mechanics
Abstract Background Partial nephrectomy (NSS) for unilateral nephroblastoma may be beneficial, although in case of regional lymph node (LN) involvement, radiotherapy counteracts the functional benefit of NSS. The aim is to verify whether decrease of tumor volume under preoperative chemotherapy implies clearance of regional LN. Procedure SIOP 9301 (1993–2001) collected 1,450 localized nephroblastoma patients of whom 1,360 (93%) had sufficiently available data and were retrospectively reviewed. Results Histologic subtypes were classically distributed. Patients were divided in those with tumor positive LN (76, 5.5%) and those with tumor negative LN (1,284, 94.5%) at surgery. In the LN(+) group, the tumor volume changed from a median of 554 (318–772) to 192 (63–458) ml = 67% (27–88%) during preoperative ChT. In the LN(−) group—377 (200–612) to 130 (44–294) ml = 62% (28–83%) (NS). Increase of tumor volume was observed in 16% of patients with LN(+), and 11% of those with LN(−) (NS); ranges are interquartile. Initial tumor volume was significantly larger in the LN(+) patients ( P = 0.00091) but not different (NS) at surgery; patients with initial tumor volume under 318 ml had the regional LN involved significantly less frequently ( P = 0.00751). Conclusions Change in tumor volume under preoperative chemotherapy is not a predictor for LN status at surgery, although larger initial volume is associated with a higher risk of LN invasion. The decrease of tumor volume is not a good criterion for the safety of NSS. The low rate of LN(+) (5.5%) indicates that this risk is low. Pediatr Blood Cancer 2011; 57: 1266–1269. © 2011 Wiley Periodicals, Inc.