Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for treatment of clear cell sarcoma of the kidney in children.

Abstract

BACKGROUND:

Clear cell sarcoma of the kidney (CCSK) is a rare and aggressive malignant renal tumor. We describe our experience with neoadjuvant transcatheter arterial chemoembolization (TACE) and systematic chemotherapy for the treatment of advanced CCSK in children.

METHODS:

Between January 2010 and December 2016, seven patients (3 boys and 4 girls; median 2.2 years) with advanced CCSK received preoperative TACE of renal artery and systemic chemotherapy. The chemoembolic emulsion for TACE consisted of cisplatin, pirarubicin, vindesine, and iodized oil. Preoperative systemic chemotherapy with vindesine, ifosfamide, and etoposide was administered three weeks after TACE. Nephrectomy was performed three weeks after systemic chemotherapy. After surgery, patients received radiotherapy and postoperative chemotherapy.

RESULTS:

No cardiotoxicity, renal insufficiency, or hepatic dysfunction was found in any patients. Grade II-III marrow suppression developed in four patients. One patient with tumor progress during neoadjuvant therapy failed to successfully undergo surgery and died. Six patients underwent nephrectomy after neoadjuvant therapy. Median follow-up period was 49.5 months (range, 11-83 months). Five patients have recurrence-free survival. One patient is still in postoperative chemotherapy after nephrectomy, radiotherapy and thoracoscopic resection of lung metastases.

CONCLUSIONS:

Neoadjuvant TACE and systemic chemotherapy appeared to be feasible in the treatment of advanced CCSK in this pilot study.

THE TYPE OF STUDY:

A case series with no comparison group.

LEVEL OF EVIDENCE:

Level IV.

• Authors: Jin-Hu Wang, Min-Ju Li, Da-Xing Tang, Shan Xu, Jun-Qing Mao, Jia-Bin Cai, Min He, Qiang Shu, Can Lai
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 54 Issue 3 Pg. 550-556 (Mar 2019) ISSN: 1531-5037 [Electronic] United States
• PMID: 30318310 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Chemical References

• Iodized Oil
• Doxorubicin
• pirarubicin
• Cisplatin
• Vindesine

Topics

• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Chemoembolization, Therapeutic (adverse effects, methods)
• Child
• Child, Preschool
• Cisplatin (administration & dosage, adverse effects)
• Combined Modality Therapy
• Doxorubicin (administration & dosage, adverse effects, analogs & derivatives)
• Female
• Humans
• Infant
• Iodized Oil (administration & dosage, adverse effects)
• Kidney (pathology)
• Kidney Neoplasms (pathology, therapy)
• Male
• Neoadjuvant Therapy (methods)
• Nephrectomy (adverse effects, methods)
• Pilot Projects
• Retrospective Studies
• Sarcoma, Clear Cell (therapy)
• Treatment Outcome
• Vindesine (administration & dosage, adverse effects)