Valor da quimioterapia pre-operatoria no tratamento do tumor de Wills

AUTOR(ES)
DATA DE PUBLICAÇÃO

2003

RESUMO

Nefrectomy was always the first therapeutic approach to treat Wilms tumor (WT). However, due to the success of chemotherapy and radiotherapy in shrinking unresectable tumors, in 1971, the Societe Internationale du Oncologie Pediatrique (SIOP) started a new protocol to evaluate the role of pre-operative treatments in children with WT. From January 1990 through December 2000, a retrospective study was done at Boldrini Children s Cancer Center in Campinas, SP, to evaluate the role of preoperative chemotherapy (POCT) in the treatment of WT. Among 91 children with WT registered in that period, 43 of them (47,2 %) have received POCT. The main indication was due to unresectable tumor at diagnosis (33 cases). Thirty-four patients (79,1 %) have showed more than 50 % reduction from the initial tumor volume. Sixteen children have had intra-operative complications (17,6 %), 12 of them in the group with no POCT (p = 0,0495). Rupture of the tumor during surgery has occurred in 13 patients (14,3 %), with a less significant number of occurrences in the POCT group (p = 0,013). Tumor rupture has showed association with abdominal recurrence (p = 0,0174). The relapse had a negative impact on survival (p = 0,0001). The main pos-operative complication was small bowel obstruction. There was no association between use of POCT and post-operative complications. Fewer children with stage III disease, who underwent POCT, have received radiotherapy, although no influence on survival was observed. Survival rate after 5 years was 81,6 %. Analysis of survival curves comparing children with stages I and II and children with stages III and IV who have received or not POCT, have showed lower survival rates in those who haven t received POCT (p = 0,0024). No major complications (grade 3 or 4 toxicities) were observed during the pre-operative treatment. We conclude that the POCT is a safe method to treat unresectable tumors at diagnosis, allowing a good shrinkage of the tumor burden and diminishing intra-operative complications.

ASSUNTO(S)

radioterapia nefroblastoma cirurgia

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