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Steur A, Raymakers-Janssen PAMA, Kneyber MCJ, Dijkstra S, van Woensel JBM, van Waardenburg DA, van de Ven CP, van der Steeg AFW, Wijnen M, Lilien MR, de Krijger RR, van Tinteren H, Littooij AS, Janssens GO, Peek AML, Tytgat GAM, Mavinkurve-Groothuis AM, van Grotel M, van den Heuvel-Eibrink MM, Asperen RMWV. Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy. Cancers (Basel) 2022; 14:cancers14040943. [PMID: 35205701 PMCID: PMC8870004 DOI: 10.3390/cancers14040943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Survival of children with Wilms tumor is excellent. However, treatment-related complications may occur, requiring treatment at the pediatric intensive care unit (PICU). The aim of our retrospective study was to assess the frequency, clinical characteristics, and outcome of 175 children with Wilms tumor requiring treatment at the PICU in the Netherlands. Thirty-three patients (almost 20%) required unplanned PICU admission during their disease course. Younger age at diagnosis, intensive chemotherapy regimens, and bilateral tumor surgery were risk factors for these unplanned PICU admissions. Three children required renal replacement therapy, two of which continued dialysis after PICU discharge. Two children died during their PICU stay. During follow up, hypertension and renal dysfunction were frequently observed, which justifies special attention for kidney function and blood pressure monitoring during and after treatment of these children. Abstract Survival rates are excellent for children with Wilms tumor (WT), yet tumor and treatment-related complications may require pediatric intensive care unit (PICU) admission. We assessed the frequency, clinical characteristics, and outcome of children with WT requiring PICU admissions in a multicenter, retrospective study in the Netherlands. Admission reasons of unplanned PICU admissions were described in relation to treatment phase. Unplanned PICU admissions were compared to a control group of no or planned PICU admissions, with regard to patient characteristics and short and long term outcomes. In a multicenter cohort of 175 children with an underlying WT, 50 unplanned PICU admissions were registered in 33 patients. Reasons for admission were diverse and varied per treatment phase. Younger age at diagnosis, intensive chemotherapy regimens, and bilateral tumor surgery were observed in children with unplanned PICU admission versus the other WT patients. Three children required renal replacement therapy, two of which continued dialysis after PICU discharge (both with bilateral disease). Two children died during their PICU stay. During follow-up, hypertension and chronic kidney disease (18.2 vs. 4.2% and 15.2 vs. 0.7%) were more frequently observed in unplanned PICU admitted patients compared to the other patients. No significant differences in cardiac morbidity, relapse, or progression were observed. Almost 20% of children with WT required unplanned PICU admission, with young age and treatment intensity as potential risk factors. Hypertension and renal impairment were frequently observed in these patients, warranting special attention at presentation and during treatment and follow-up.
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Affiliation(s)
- Anouk Steur
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Paulien A. M. A. Raymakers-Janssen
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
- Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands
| | - Martin C. J. Kneyber
- Division of Pediatric Critical Care Medicine, Beatrix Children’s Hospital/University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.C.J.K.); (S.D.)
| | - Sandra Dijkstra
- Division of Pediatric Critical Care Medicine, Beatrix Children’s Hospital/University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.C.J.K.); (S.D.)
| | - Job B. M. van Woensel
- Department of Pediatric Intensive Care, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands;
| | - Dick A. van Waardenburg
- Department of Pediatric Intensive Care, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
| | - Cornelis P. van de Ven
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Alida F. W. van der Steeg
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Marc Wijnen
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Marc R. Lilien
- Department of Pediatric Nephrology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands;
| | - Ronald R. de Krijger
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
- Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Annemieke S. Littooij
- Department of Radiology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands;
| | - Geert O. Janssens
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Annemarie M. L. Peek
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Godelieve A. M. Tytgat
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Annelies M. Mavinkurve-Groothuis
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Martine van Grotel
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Roelie M. Wösten-van Asperen
- Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands
- Correspondence:
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Miura H, Kawana S, Sugino S, Kikuchi C, Yamauchi M. Successful management of an infant with hypertensive heart failure associated with Wilms' tumor: a case report. JA Clin Rep 2020; 6:12. [PMID: 32056027 PMCID: PMC7018917 DOI: 10.1186/s40981-020-00318-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/04/2020] [Indexed: 01/30/2023] Open
Abstract
Background Wilms’ tumor with hyperreninemia may result in critical cardiovascular decompensation. We report a case of severe hypertensive heart failure followed by tumor resection in a 3-month-old infant with Wilms’ tumor. Case presentation A 3-month-old girl was admitted to the intensive care unit for Wilms’ tumor with hypertension and hypoxia. Her systolic blood pressure was 110 mmHg, and her SpO2 was 92%. She presented with severe hypertensive heart failure and received mechanical ventilation and antihypertensive therapy for hypertension and heart failure. An alpha 2-adrenergic receptor agonist was used for sedation as part of her antihypertensive therapy. On hospital day 16, nephrectomy with tumor resection was performed under general anesthesia. Her systolic blood pressure did not vary more than 20 mmHg during surgery due to appropriate preoperative management. Hemodynamic collapse did not occur. Conclusions The highlight of this case report is the successful management of an infant with Wilms’ tumor, particularly with respect to preoperative hemodynamic control and sedation.
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Affiliation(s)
- Hiroko Miura
- Department of Anesthesia, Miyagi Children's Hospital, 3-17, Ochiai 4, Aoba-ku, Sendai, Miyagi, 989-3126, Japan. .,Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Shin Kawana
- Department of Anesthesia, Miyagi Children's Hospital, 3-17, Ochiai 4, Aoba-ku, Sendai, Miyagi, 989-3126, Japan
| | - Shigekazu Sugino
- Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Chika Kikuchi
- Department of Anesthesia, Miyagi Children's Hospital, 3-17, Ochiai 4, Aoba-ku, Sendai, Miyagi, 989-3126, Japan
| | - Masanori Yamauchi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Probst PJ, Assadi A, Gleason J. Botryoid Wilms Tumor: A Rare Diagnosis With an Atypical Presentation. Urology 2019; 126:192-194. [PMID: 30735745 DOI: 10.1016/j.urology.2019.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/15/2022]
Abstract
Wilms tumor commonly presents as an asymptomatic abdominal mass. In some cases, it can be accompanied with hypertension, constitutional symptoms, and hematuria when involving the collecting system. Below, we review the case of a child diagnosed with botryoid Wilms tumor involving the upper calyces and renal pelvis in which the presenting symptom was a concern for a foreign body in her left ear, and the only abnormality during initial history and physical examination was stage II hypertension.
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Affiliation(s)
- Patrick J Probst
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN; Division of Pediatric Urology, LeBonheur Children's Hospital, Memphis, TN; Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Akram Assadi
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN; Division of Pediatric Urology, LeBonheur Children's Hospital, Memphis, TN; Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Joseph Gleason
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN; Division of Pediatric Urology, LeBonheur Children's Hospital, Memphis, TN; Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.
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Gold SA, Sabarwal VK, Gordhan C, Hale GR, Winer A. Lymph node imaging of pediatric renal and suprarenal malignancies. Transl Androl Urol 2018; 7:774-782. [PMID: 30456181 PMCID: PMC6212619 DOI: 10.21037/tau.2018.07.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pediatric renal and suprarenal cancers are relatively rare malignancies, but are not without significant consequence to both the patient and caretakers. These tumors are often found incidentally and present as large abdominal masses. Standard of care management involves surgical excision of the mass, but contemporary treatment guidelines advocate for use of neoadjuvant or adjuvant chemotherapy for advanced stage disease, such as those cases with lymph node involvement (LNI). However, LNI detection is based primarily on surgical pathology and performing extended lymph node dissection can add significant morbidity to a surgical case. In this review, we focus on the use and performance of imaging modalities to detect LNI in Wilms’ tumor (WT), neuroblastoma, and pediatric renal cell carcinoma (RCC). We report on how imaging impacts management of these cases and the clinical implications of LNI. A literature search was conducted for studies published on imaging-based detection of LNI in pediatric renal and suprarenal cancers. Further review focused on surgical and medical management of those cases with suspected LNI. Current imaging protocols assisting in diagnosis and staging of pediatric renal and suprarenal cancers are generally limited to abdominal ultrasound and cross-sectional imaging, mainly computed tomography (CT). Recent research has investigated the role of more advance modalities, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), in the management of these malignancies. Special consideration must be made for pediatric patients who are more vulnerable to ionizing radiation and have characteristic imaging features different from adult controls. Management of pediatric renal and suprarenal cancers is influenced by LNI, but the rarity of these conditions has limited the volume of clinical research regarding imaging-based staging. As such, standardized criteria for LNI on imaging are lacking. Nevertheless, advanced imaging modalities are being investigated and potentially represent more accurate and safer options.
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Affiliation(s)
- Samuel A Gold
- SUNY Downstate College of Medicine, Downstate Medical Center, Brooklyn, NY, USA
| | - Vikram K Sabarwal
- Department of Urology, George Washington University Hospital, Washington, DC, USA
| | - Chirag Gordhan
- Department of Urology, George Washington University Hospital, Washington, DC, USA
| | - Graham R Hale
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, NY, USA
| | - Andrew Winer
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Jastaniah W, Elimam N, Alluhaibi RS, Alharbi AT, Abbas AA, Abrar MB. The prognostic significance of hypertension at diagnosis in children with wilms tumor. Saudi Med J 2017; 38:262-267. [PMID: 28251221 PMCID: PMC5387902 DOI: 10.15537/smj.2017.3.15991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the prognostic effect of hypertension at diagnosis on outcomes of children with Wilms tumor (WT). Methods: A single center retrospective analysis was conducted on 85 consecutive children with WT diagnosed between January 2000 and August 2013. Patients were classified as hypertensive or normotensive at diagnosis. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Cox regression was used to determine the predictive significance of hypertension and other clinical factors. Results: Seventy-one patients had complete data. Of this, 25 (35.2%) were hypertensive and 46 (64.8%) normotensive with corresponding remission rates of 56.0% versus 82.6%, p=0.032; and death as first event of 7% versus 0%, p=0.004. The 5-year OS in the hypertensive versus normotensive patients were (67.1±10.3% versus 89.6±4.9%, p=0.009) and the corresponding 5-year PFS were (53.4±10.4% versus 79.1±6.2%, p=0.007). With univariate analysis, hypertension and local stage were predictors of OS (p=0.012 and p=0.029) and PFS (p=0.030 and p=0.008). In the multivariate analysis, hypertension, local stage, and histopathology were identified as independent prognostic factors of OS (p=0.004, p=0.034, and p=0.038); and hypertension and local stage as prognostic for PFS (p=0.010 and p=0.012). Conclusion: Hypertension at diagnosis is a prognostic predictor of poor outcome in WT and may signify tumor resistance.
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Affiliation(s)
- Wasil Jastaniah
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia. E-mai.
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Provenzi VO, Rosa RFM, Rosa RCM, Roehe AV, dos Santos PPA, Faulhaber FRS, de Oliveira CAV, Zen PRG. Wilms tumor: experience of a hospital in southern Brazil. Pediatr Int 2014; 56:534-40. [PMID: 24447407 DOI: 10.1111/ped.12295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 09/25/2013] [Accepted: 12/26/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Wilms tumor (WT) is the most common renal malignancy of childhood. The aim of this study was to verify the epidemiological profile and prognosis of a sample of patients from Brazil and compare them to similar data from other Latin American studies. METHOD The sample consisted of consecutive patients diagnosed with WT in an oncohematology service of a referral hospital in Southern Brazil, between 1989 and 2009. Clinical, radiological, pathological and survival data were collected from the medical records. Analysis was done using Excel and SPSS version 18.0. The significance level was set at P < 0.05. RESULTS The final sample consisted of 45 patients. The male/female ratio was 1.25:1. Mean age at diagnosis was 43.9 months and all patients were of European descent. Thirty-three patients (73.3%) had both signs/symptoms of abdominal mass and hypertension. Malformation was observed in nine patients (20%) and there was one case of Fanconi's anemia (2.2%). Three patients had bilateral disease (6.7%). The majority of patients had stage III and IV (62.2%). Patients with malformation had an earlier age at diagnosis (P = 0.018) and a higher prevalence of bilateral disease (P = 0.044). Overall survival was 75%. Age at diagnosis was the only significant independent predictor associated with death. CONCLUSION Death is closely related to late diagnosis in WT. Oncologic services should also be concerned about morbidity caused by therapeutic options in cases of late diagnosis, and the consequences for quality of life.
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Latham GJ, Greenberg RS. Anesthetic considerations for the pediatric oncology patient--part 2: systems-based approach to anesthesia. Paediatr Anaesth 2010; 20:396-420. [PMID: 20199611 DOI: 10.1111/j.1460-9592.2010.03260.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
One of the prices paid for chemo- and radiotherapy of cancer in children is damage to the vulnerable and developing healthy tissues of the body. Such damage can exist clinically or subclinically and can become apparent during active antineoplastic treatment or during remission decades later. Furthermore, effects of the tumor itself can significantly impact the physiologic state of the child. The anesthesiologist who cares for children with cancer or for survivors of childhood cancer should understand what effects cancer and its therapy can have on various organ systems. In part two of this three-part review, we review the anesthetic issues associated with childhood cancer. Specifically, this review presents a systems-based approach to the impact from both tumor and its treatment in children, followed by a discussion of the relevant anesthetic considerations.
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Affiliation(s)
- Gregory J Latham
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way N.E., Seattle, WA 98105, USA.
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Maas MH, Cransberg K, van Grotel M, Pieters R, van den Heuvel-Eibrink MM. Renin-induced hypertension in Wilms tumor patients. Pediatr Blood Cancer 2007; 48:500-3. [PMID: 16794999 DOI: 10.1002/pbc.20938] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Since the report that hypertension associated with Wilms tumor (WT) may be renin-induced, no larger series than 13 patients have been published. Nevertheless, angiotensin converting enzyme (ACE) inhibitors have become treatment of choice for hypertension in WT patients. The purpose of this study was to investigate the correlation between plasma renin levels and blood pressure in a larger cohort of WT patients. PROCEDURE In this retrospective, single-center study, data on blood pressure and plasma renin were analyzed in 86 WT patients treated according to the consecutive SIOP protocols 6, 9, 93-01, and 2001. RESULTS At diagnosis, 47 WT patients suffered from hypertension (55%). In 31 of these patients plasma renin levels were analyzed; increased plasma renin levels were found in 25/31 patients (81%). In contrast, normal plasma renin levels were measured in 8/13 of the patients with a normal blood pressure (P = 0.012). Twenty-eight children received antihypertensive treatment before surgery, in 25 of them blood pressure normalized before surgery. Blood pressure was normal directly after surgery in all patients but 4, in whom blood pressure recovered to normal within a few weeks. CONCLUSIONS This retrospective study shows that hypertension in WT patients is associated with elevated plasma renin levels, indicating that ACE inhibitors may be a good therapeutic option in at least a subset of WT patients with hypertension before nephrectomy.
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Affiliation(s)
- M H Maas
- Department of Pediatric Oncology/Hematology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
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Madre C, Orbach D, Baudouin V, Brisse H, Bessa F, Schleiermacher G, Pacquement H, Doz F, Michon J. Hypertension in childhood cancer: a frequent complication of certain tumor sites. J Pediatr Hematol Oncol 2006; 28:659-64. [PMID: 17023826 DOI: 10.1097/01.mph.0000212995.56812.bb] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED The clinical features and management of severe hypertension (HT) (blood pressure > 99th percentile + 5 mm Hg) have been rarely described in pediatric oncology. OBJECTIVES Retrospective descriptive study of the case files of 31 patients followed in the Institut Curie Department of Pediatric Oncology between 1999 and 2004 and presenting severe HT at the time of diagnosis of their tumor. RESULTS The median age was 2 years 1 month (range: 3 mo to 6 y 8 mo). Median blood pressure was 99th percentile + 30 mm Hg (range: 99th percentile + 7 mm Hg to 99th percentile + 62 mm Hg). The tumors presented by these children were: Wilms tumor (n=17, ie, 20% of all Wilms tumors treated during this period), neuroblastoma (n=12, ie, 10% of all neuroblastomas treated during this period) or other tumors (n=2). HT was asymptomatic in all children. Initial management consisted of etiologic treatment by primary chemotherapy and/or surgical resection of the tumor, associated with antihypertensive therapy, initially administered by intravenous injection for 12 children (nicardipine, labetalol) and then orally in all children (calcium channel blockers, n=23; angiotensin-converting enzyme inhibitor, n=16; beta-blockers, n=4; alpha/beta-blockers, n=2; diuretics, n=1). Dual therapy was necessary in 7 cases and triple therapy was necessary in 1 case. The median duration of antihypertensive therapy was 40 days (range: 9 to 195). No child developed a serious complication of HT. CONCLUSIONS Initial HT is a frequent complication of Wilms tumor and neuroblastoma and affects young children (< 2.5 y). It is often severe, asymptomatic, but needs specific treatment and resolves after treatment of the tumor.
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Affiliation(s)
- Simon D Whyte
- Department of Pediatric Anesthesia, British Columbia's Children's Hospital, Oak Street, Vancouver, BC, Canada.
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Abstract
Hypertension is a frequent problem in children with renal tumour, yet there are few reports from centres in the third world. A retrospective study of blood pressure in a cohort of 46 patients with renal tumours seen over a 3-year period was carried out. Fifty percent of patients presenting with Wilms' tumour were hypertensive. Serum concentrations of active renin correlated poorly with blood pressure. There was no correlation between serum concentrations of active renin and tumour mass or histology. Specific antihypertensive therapy was offered to 11 patients who had either neurological or cardiac complications of hypertension. All other patients with Wilms' tumour had their blood pressure controlled by neoadjuvant chemotherapy. Patients with mesoblastic nephroma were managed by primary surgery. Patients with asymptomatic hypertension may be monitored as hypertension will resolve with neoadjuvant chemotherapy. Those with compelling symptomatology will require additional hypertensive medication.
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Affiliation(s)
- G P Hadley
- Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, Private Bag 7, 4013 Durban, South Africa.
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Abstract
BACKGROUND Because of suggestions that hypertension may increase the long-term risk of cancer, we assessed the relation between hypertension and malignancy. METHODS We conducted a MEDLINE search of English-language articles published between January 1966 and January 2000 using the terms hypertension or blood pressure, and neoplasm or cancer or malignancy. We reviewed prospective studies that reported cancer incidence or mortality in hypertensive and nonhypertensive patients, case-control studies that reported the prevalence of hypertension in cancer patients and controls, and references from identified articles. RESULTS We identified 10 longitudinal studies that evaluated the association between blood pressure and cancer mortality in 47 119 subjects. Subjects with hypertension experienced an increased rate of cancer mortality during durations of follow-up ranging 9 to 20 years, with an age- and smoking-adjusted pooled odds ratio of 1.23 (95% confidence interval [CI]: 1.11 to 1.36). In 13 case-control studies, including 6964 cases of renal cell cancer and 9181 controls, the adjusted odds ratio for renal cell cancer among hypertensive patients, relative to normotensive counterparts, was 1.75 (95% CI: 1.61 to 1.90). No clear association was found between hypertension and cancer of other sites. CONCLUSION Hypertension was associated with an increased risk of mortality from cancer, particularly renal cell carcinoma.
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Affiliation(s)
- Ehud Grossman
- Department of Internal Medicine D (EG), Chaim Sheba Medical Center, Tel-Hashomer, Israel
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Fong KW, Lee ACW, Wong YC, Lee WK, Tsui KY. Wilms tumor presenting as superior vena cava syndrome. MEDICAL AND PEDIATRIC ONCOLOGY 2002; 38:135-6. [PMID: 11813185 DOI: 10.1002/mpo.1291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- K W Fong
- Department of Paediatrics, Tuen Mun Hospital, New Territories, Hong Kong, China
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15
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CURRENT CONCEPTS IN THE BIOLOGY AND MANAGEMENT OF WILMS TUMOR. J Urol 1998. [DOI: 10.1097/00005392-199804000-00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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WIENER JOHNS, COPPES MAXJ, RITCHEY MICHAELL. CURRENT CONCEPTS IN THE BIOLOGY AND MANAGEMENT OF WILMS TUMOR. J Urol 1998. [DOI: 10.1016/s0022-5347(01)63608-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- JOHN S. WIENER
- Scott Department of Urology, Baylor College of Medicine, and Departments of Surgery and Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas, and Departments of Oncology and Pediatrics, University of Calgary Medical School, Alberta, Canada
| | - MAX J. COPPES
- Scott Department of Urology, Baylor College of Medicine, and Departments of Surgery and Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas, and Departments of Oncology and Pediatrics, University of Calgary Medical School, Alberta, Canada
| | - MICHAEL L. RITCHEY
- Scott Department of Urology, Baylor College of Medicine, and Departments of Surgery and Pediatrics, University of Texas Health Science Center at Houston, Houston, Texas, and Departments of Oncology and Pediatrics, University of Calgary Medical School, Alberta, Canada
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