Impact of neoadjuvant chemotherapy on thrombus viability in patients with Wilms tumour and caval extension: systematic review with meta-analysis
| Autor: | M Gabriel, P D Losty, R Shukla, T D Boam |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
AcademicSubjects/MED00910 medicine.medical_treatment Vena Cava Inferior Logistic regression Inferior vena cava Wilms Tumor 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Medicine Humans cardiovascular diseases Thrombus Child Retrospective Studies Chemotherapy business.industry Thrombosis General Medicine Odds ratio Vascular surgery medicine.disease Chemotherapy regimen Kidney Neoplasms Neoadjuvant Therapy medicine.vein 030220 oncology & carcinogenesis Meta-analysis cardiovascular system Radiology Systematic Review business AcademicSubjects/MED00010 |
| Zdroj: | BJS OPEN BJS Open |
| Popis: | Background Inferior vena cava (IVC) tumour thrombus in children with Wilms tumour is typically managed with neoadjuvant chemotherapy with the intention of achieving thrombus regression in order to minimize the risks associated with complex vascular surgery. Methods A systematic review of Medline and Embase databases was undertaken to identify all eligible studies with reference to thrombus viability in Wilms tumour index cases with caval/cardiac extension. A meta-analysis of proportions was utilized for pooled thrombus viability data across studies. Logistic regression was used to analyse the relationship between thrombus viability and duration of chemotherapy. Results Thirty-five eligible observational studies and case reports met inclusion criteria describing a total of 236 patients with thrombus viability data. The pooled proportion of patients with viable tumour thrombus after neoadjuvant chemotherapy was 0.53 (0.43–0.63). Logistic regression analysis of 54 patients receiving either a standard (4–6 weeks) or extended (more than 6 weeks) course of neoadjuvant chemotherapy resulted in an odds ratio of 3.14 (95 per cent c.i. 0.97 to 10.16), P = 0.056, with extended course therapy trending towards viable tumour thrombus. Conclusion Preoperative chemotherapy is successful in achieving non-viability of caval and cardiac thrombi in around 50 per cent of children, without added benefit from extended cycles of neoadjuvant chemotherapy. Risks versus benefits of extirpative vascular surgery must be considered, therefore, for these high-risk patients. |
| Databáze: | OpenAIRE |
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