Neoadjuvant transcatheter arterial chemoembolization and systemic chemotherapy for treatment of clear cell sarcoma of the kidney in children
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In brief
In brief
Pilot study of seven pediatric patients with advanced clear cell sarcoma of the kidney treated with combined neoadjuvant TACE and systemic chemotherapy before nephrectomy. Six of seven patients successfully underwent surgery with five achieving recurrence-free survival at median 49.5-month follow-up, suggesting this approach may be feasible for advanced disease.
Written by the GCMD Library team from the article.
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.