St. Jude study offers new hope for children with kidney tumors deemed inoperable

Since 1999, St. Jude patients whose bilateral Wilms tumor exhibits favorable histology have received chemotherapy, consisting of vincristine, dactinomycin and doxorubicin, followed by bilateral partial nephrectomies within 12 weeks of initiation of chemotherapy. Patients in the retrospective study ranged in age from 5 months to 9 years old and were generally referred to St. Jude because of poor response to therapy or unfavorable anatomy. Many of the children received radiation after undergoing surgery.

According to Davidoff, nephron-sparing surgery is a more complex procedure than a complete nephrectomy. “Commonly, when a child has bilateral disease, the surgeon will remove the kidney that has the most tumor and do a partial nephrectomy on the other side,” he said. “But if a patient then develops problems in the remaining kidney, the options are limited because one kidney has been taken out of the equation. At St. Jude, we try to save as much kidney as possible in children with bilateral disease. Thus far, 100 percent of the time we have been able to save normal kidney on both sides.”

All patients who exhibited favorable histology Wilms tumor are still alive, a mean of nearly four years after initial surgery. Nine of the patients exhibited normal renal function at their most recent follow-up exams.

Other authors of this paper include Jesse J. Jenkins and Matthew J. Krasin (St. Jude); Mark A. Williams and Deborah P. Jones (St. Jude and University of Tennessee, Memphis); Dana W. Giel (University of Tennessee, Memphis); Fredric A. Hoffer (University of Washington, formerly of St. Jude); and Jeffrey S. Dome (Children’s National Medical Center, formerly of St. Jude and the University of Tennessee, Memphis).

This work was supported by a U.S. Public Health Service Childhood Solid Tumor Program grant, a Cancer Center Support Grant from the National Cancer Institute and ALSAC.

St. Jude Children's Research Hospital

St. Jude Children's Research Hospital is internationally recognized for its pioneering work in finding cures and saving children with cancer and other catastrophic diseases. Founded by late entertainer Danny Thomas and based in Memphis, Tenn., St. Jude freely shares its discoveries with scientific and medical communities around the world. No family ever pays for treatments not covered by insurance, and families without insurance are never asked to pay. St. Jude is financially supported by ALSAC, its fundraising organization. For more information, please visit www.stjude.org.