Effectiveness of preoperative chemotherapy in the treatment of Wilms tumor with vena caval and intracardiac extension.

Surgical treatment of Wilms tumor with vena caval and intracardiac extension is challenging, often requiring cardiopulmonary bypass. We report the response to preoperative chemotherapy in 3 patients following a protocol at our hospital. The tumor thrombus was limited to the inferior vena cava in 2 patients and extended to the right atrium in 1. All 3 patients had marked reduction or complete eradication of the venous thrombus, facilitating the final surgical procedure. The patients are disease-free 18 months to 7 years after the initial treatment. Our protocol involves initial radiographic staging followed by needle biopsy, chemotherapy, repeat radiographic staging, definitive resection and additional chemotherapy. Our results confirm the effectiveness of this approach, which appears to decrease morbidity associated with intracaval and intra-atrial tumor extension.