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Quimioterapia preoperatoria en el tumor de Wilms

Preoperative chemotherapy for Wilm’s tumor

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Abstract

Objetivos

1. Valorar el efecto de la quimioterapia preoperatoria (QTP) sobre el tamaño y las características ecográficas del tumor de Wilms (TW).2. Investigar qué variables clínicas e histológicas influyen en los cambios ecográficos encontrados.

Pacientes y métodos

Se revisaron 22 casos (12 niñas) de 0,5–12 años. Se realizaron 3 ecografías a cada paciente (previa a la QTP, tras el segundo ciclo y al finalizarla). Se consideró “buena respuesta” una disminución del volumen mayor del 50%. Se compararon edad, sexo, forma de presentación clínica, lateralidad, tamaño, patrón ecográfico, extensión, características macroscópicas y tipo histológico entre “buenos” y “malos respondedores”.

Resultados

La QTP redujo más de un 50% el volumen tumoral en 16/22 casos, produjo o aumentó las áreas necróticas y calcificadas del tumor en 16/22 y 8/22, respectivamente, y disminuyó su vascularización en 6 de los 12 casos que contaron con ecografía-Doppler. De 5 pacientes con metástasis al diagnóstico, 3 quedaron libres de ellas. En los 3 pacientes de edad entre 6 meses y un año la respuesta fue mala. De los 4 tumores de alto riesgo histológico (formas sarcomatosas, rabdoides y anaplásicas), los 2 sarcomas respondieron bien, no haciéndolo así el rabdoide ni el anaplásico.

Conclusiones

1. La QTP en niños con TW reduce el volumen tumoral, aumenta las áreas de necrosis y disminuye su vascularización.2. La respuesta a la QTP parece peor en lactantes y en tumores de alto riesgo.

Abstract

Objectives

1. To assess preoperative chemotherapy (PCT) effect on size and sonographic features of Wilms’ tumor (WT).2. To study clinical and histologic variables that are related to imaging changes.

Patients and methods

22 children (12 female) aged 0,5 to 12 years were reviewed. Three sonographic studies per patient were made (before PCT, after its second cycle and at its end). 50% volume decrease was considered as a “good response”. Age, sex, clinical onset, side, size, sonographic aspect, extension, macroscopic and histologic features were compared in “good” and “bad responders”.

Results

PCT decreased more than 50% tumor volume in 16/22 cases, produced or increased necrosis areas in 16/22 and calcification areas in 8/22 and decreased vascularity in 6/12. 3/5 patients with metastasis at diagnosis became free of them. All three patients aged 0,5 to 1 year were “bad responders”. Response was good in two sarcomas, but not in the other two children with histologic high risk tumors (rabdoide and anaplasic types).

Conclusions

1. PCT for children with WT decreases tumor volume, increases necrosis areas and decreases vascularity.2. Infants and high risk tumors seem to have poorer response to PCT.

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Authors and Affiliations

  1. Unidad de Oncología, Spain

    Emilio García-García, Antonio Herreroa & Tomás Acha

  2. Ecografía pediátricas, Hospital Materno-Infantil. Complejo Hospitalario Carlos Haya, Málaga

    M. Teresa Hidalgo, Esperanza Valls & María Martínez-León

Authors
  1. Emilio García-García
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  2. M. Teresa Hidalgo
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  3. Antonio Herreroa
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  4. Tomás Acha
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  5. Esperanza Valls
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  6. María Martínez-León
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Correspondence to Emilio García-García.

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García-García, E., Hidalgo, M.T., Herreroa, A. et al. Quimioterapia preoperatoria en el tumor de Wilms. Rev Oncología 2, 74–77 (2000). https://doi.org/10.1007/BF02979469

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