病例報告: 小兒腎尤文氏肉瘤治療:有無術前化學藥物治療後手術合併術後化學藥物治療及放射線治療
鄭隆峯1、余家政1,2,3、吳東霖1
1高雄榮民總醫院外科部泌尿外科
2國防醫學中心三軍總醫院外科部泌尿外科
3大仁科技大學藥學系
Cases report: Pediatric Primary renal Ewing sarcoma treatment : Surgery plus adjuvant chemotherapy plus radiotherapy with/without neo-adjuvant chemotherapy
Lung-Feng Cheng1、Chia-Cheng Yu1,2,3、Tong-Lin Wu1,3
1 Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital
2 Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
3 Department of Pharmacy, Tajen University
Abstract:
Ewing sarcoma arising from kidney has been considered poor prognosis. Surgical extirpation combined with chemotherapy (C/T), and/or radiotherapy (R/T) are the mainstay of treatment. We report two cases at Kaohsiung Veterans General Hospital. We discuss their treatment and outcome to guess which choice is better.
The 14-year-old girl with no congenital abnormality suffered from a left huge renal mass. Renal cell carcinoma was initially suspected and radical nephrectomy was performed. But pathology showed the primitive neuroectodermal tumor (Ewing sarcoma), with pancreas tail invasion (noted by intra- operative Frozen). She received adjuvant C/T ( total 48 times). Besides, R/T with 45Gy was also performed. Another one was a healthy 17-year-old boy who also had a left large renal mass with suspected lung metastasis and IVC thombus. Biopsy was firstly done and primitive neuroectodermal tumor was diagnosed. Neo-adjuvant C/T were given. Then, radical nephrectomy, with IVC thrombectomy were performed and adjuvant C/T (total 51 times ) + R/T (chest and abdomen )with 54Gy.
The girl has followed 48 months till now. Lung metastases (left upper and left lower) were found in 6 months later after adjuvant C/T completed. She received wedge resection of lung metastases, radiotherapy and relapse C/T. Interestingly, the boy’s pre-operative computed tomography showed the tumor burden decreased. He has followed 30 months till now. No obvious relapse notes after C/T completed 10 months earlier.
According to our experience, neo-adjuvant C/T and then followed locally control combine adjuvant C/T and R/T is better. Pediatric renal mass is difficult to diagnose. If biopsy is used to survey pathohistology initially, neo-adjuvant C/T may be feasible. But more follow-up time and cases must be needed to evaluate outcome.