mesna and Wilms-Tumor

Bilateral Wilms' tumors represent a therapeutic challenge. The primary aim of management is eradication of the neoplasm and preservation of renal function. We present our experience in the management of such cases in a single-center experience.. This was a retrospective study of 22 patients with histologically proven bilateral nephroblastoma who were treated from 1993 to 2008 at our center. Of the 22 patients, 12 were girls and 10 were boys, with a median age of 3 years (range 1-9); 19 had a synchronous presentation and 3 a metachronous presentation. Of the 22 patients, 6 underwent initial surgical resection followed by chemotherapy and 16 underwent initial biopsy and preoperative chemotherapy. The final oncologic and renal outcomes were assessed.. The median follow-up period was 3 years (range 1-11). Of the 22 patients, 8 died, for an overall survival rate of 63.5%. The survival for the initial chemotherapy and initial surgery groups was essentially similar. Of all the variables studied, unfavorable histologic findings had a significant negative effect on survival. Of the 5 patients with unfavorable histologic findings, 4 died during the follow-up period. The median volume of preserved renal parenchyma was 40%. All patients had good renal function during follow-up, except for 1 patient who had undergone bilateral nephrectomy.. Bilateral Wilms' tumors impose 2 conflicting issues: elimination of the pathology and preservation of the renal function. Currently, treatment regimens involving initial chemotherapy followed by conservative surgery can achieve these goals in an important proportion of patients.

Topics: Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Child; Child, Preschool; Combined Modality Therapy; Dactinomycin; Doxorubicin; Egypt; Etoposide; Female; Follow-Up Studies; Humans; Ifosfamide; Infant; Kaplan-Meier Estimate; Kidney Neoplasms; Male; Mesna; Neoadjuvant Therapy; Neoplasms, Multiple Primary; Neoplasms, Second Primary; Nephrectomy; Retrospective Studies; Treatment Outcome; Vincristine; Wilms Tumor

Pigmented banding of the nails and hyperpigmentation of hands and feet may occur during cyclophosphamide therapy. Ifosfamide, an analogue of cyclophosphamide, might be expected to cause similar pigmentary changes, but, to the knowledge of the authors, there are no reports of this.. The authors describe skin pigment changes in a 5-year-old patient receiving ifosfamide, MESNA, and etoposide for the treatment of relapsed Wilms tumor.. A review of the literature concerning cyclophosphamide-induced pigmentary changes is presented, along with a discussion of the possible correlation of renal dysfunction with pigmentary changes.. This case should alert health care providers to this uncommon adverse effect of ifosfamide.

Topics: Child, Preschool; Etoposide; Humans; Ifosfamide; Kidney Neoplasms; Lung Neoplasms; Male; Mesna; Pigmentation Disorders; Wilms Tumor

A right-sided renal mass in an 11-month-old girl was diagnosed by percutaneous needle biopsy as Wilms tumor, which on histologic examination was found to be predominantly rhabdomyomatous. As part of the examination, serum creatine kinase (CK) and CK-MB levels were measured and were significantly elevated at 994 U/L (reference range, 42-180 U/L) and 40 U/L (reference range, 0-3 U/L), respectively. Subsequently, an 8-month-old girl was admitted to the hospital with septicemia and was found to have an abdominal mass. A diagnosis of bilateral Wilms tumor was made following percutaneous biopsy of both kidneys; histologic examination confirmed that the tumor was predominantly rhabdomyomatous. Serum CK and CK-MB levels also were measured and were significantly elevated at 685 U/L and 84.4 U/L, respectively. In both cases, the serum CK and CK-MB levels reflected the clinical course; elevation in serum levels was associated with tumor recurrence, infarction, or chemotherapy-related necrosis. We conclude that these enzymes have clinical usefulness as markers for Wilms tumor showing rhabdomyomatous morphologic features.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Creatine Kinase; Dactinomycin; Disease Progression; Disease-Free Survival; Doxorubicin; Etoposide; Fatal Outcome; Female; Humans; Ifosfamide; Infant; Kidney Neoplasms; Mesna; Neoplasm Recurrence, Local; Nephrectomy; Reference Standards; Rhabdomyoma; Vincristine; Wilms Tumor

The purpose of this study was to evaluate the antitumor activity and tolerability of ifosfamide (IFO) at a dose of 3 g/m2, given on 2 consecutive days every 2 weeks, in advanced Wilms' tumor patients in whom conventional therapy had failed. Mesna and hyperhydration were concomitantly given to minimize bladder toxicity. A total of 21 patients with advanced Wilms' tumor were entered in the study. The response observed after two courses was complete in 6 patients and partial in 5; 10 did not respond; the median duration of response was 2 months (range, 1-7 months). Leucopenia caused a delay in therapy for 1 or 2 weeks in only three cases. Neither fever nor infection were observed. Of 7 patients who developed hematuria, 3 were among the 17 who concurrently received mesna. The urotoxicity did not interfere with subsequent therapy in these three cases.

Topics: Adolescent; Adult; Child; Child, Preschool; Drug Evaluation; Drug Therapy, Combination; Humans; Ifosfamide; Infant; Kidney Neoplasms; Mesna; Neoplasm Recurrence, Local; Remission Induction; Time Factors; Wilms Tumor