Management and Outcomes of Wilms Tumor With Suprarenal Intravascular Extension
Bindi Naik‐Mathuria, Alan F. Utria, Peter F. Ehrlich, Jennifer H. Aldrink, Andrew J. Murphy, Timothy B. Lautz, Roshni Dasgupta, Scott S. Short, Harold N. Lovvorn, Eugene S. Kim, Erica Newman, Dave R. Lal, Barrie S. Rich, Nelson Piché, Zachary J. Kastenberg, Marcus M. Malek, Richard D. Glick, Robin T. Petroze, Stephanie F. Polites, Richard S. Whitlock, Elizabeth Alore, Pattamon Sutthatarn, Stephanie Chen, Shannon Wong‐Michalak, Rodrigo Romao, Ameer Al‐Hadidi, Nathan S. Rubalcava, John Marquart, Hailey Gainer, Mike Johnson, Chloé Boehmer, Hannah Rinehardt, Natashia M. Seemann, Jacob Davidson, Valerie E. Polcz, Sarah Lund, Katlyn G. McKay, Hernán Correa, David H. Rothstein
Abstract
OBJECTIVE: The purpose of this study was to describe management and outcomes from a contemporary cohort of children with Wilms tumor complicated by inferior vena caval thrombus. BACKGROUND: The largest series of these patients was published almost 2 decades ago. Since then, neoadjuvant chemotherapy has been commonly used to manage these patients, and outcomes have not been reported. METHODS: Retrospective review of 19 North American centers between 2009 and 2019. Patient and disease characteristics, management, and outcomes were investigated and analyzed. RESULTS: Of 124 patients, 81% had favorable histology (FH), and 52% were stage IV. IVC thrombus level was infrahepatic in 53 (43%), intrahepatic in 32 (26%), suprahepatic in 14 (11%), and cardiac in 24 (19%). Neoadjuvant chemotherapy using a 3-drug regimen was administered in 82% and postresection radiation in 90%. Thrombus level regression was 45% overall, with suprahepatic level showing the best response (62%). Cardiopulmonary bypass (CPB) was potentially avoided in 67%. The perioperative complication rate was significantly lower after neoadjuvant chemotherapy [(25%) vs upfront surgery (55%); P =0.005]. CPB was not associated with higher complications [CPB (50%) vs no CPB (27%); P =0.08]. Two-year event-free survival was 93% and overall survival was 96%, higher in FH cases (FH 98% vs unfavorable histology/anaplastic 82%; P =0.73). Neither incomplete resection nor viable thrombus cells affected event-free survival or overall survival. CONCLUSIONS: Multimodal therapy resulted in excellent outcomes, even with advanced-stage disease and cardiac extension. Neoadjuvant chemotherapy decreased the need for CPB to facilitate resection. Complete thrombectomy may not always be necessary.