Copyright Prof. Dr. Graf, Homburg
Prognosis of Nephroblastoma since 1915 Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Symptoms in Wilms´ Tumor 56 % Pain 25 % Haematuria 18 % Fever 10 % Urinary tract infection 6 % Weight loss 5 % Constipation Enteritis 4 % Vomiting Other 19 % 0% 20% 40% 60% 80% 100% symptomatic other symptoms U3 - U9 (no symptoms) Symptoms in Wilms´ Tumor Gutjahr P: Bundesweite Wilmstumor-Studie 1980 bis 1988. Dt Ärztebl 87:B2130-B2134, 1990 Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Differential Diagnosis Other malignancies : Neuroblastoma Adenocarcinoma of kidney Lymphoma Langerhans Cell Histiocytosis Teratoma Benign diseases : Abscess of the kidney Fibroma of the kidney Haematoma Hydronephrosis Cystadenoma Ganglioneuroma Hamartoma Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Frequency of congenital Anomalities Anomalia NWTS [%] SIOP [%] CNS 0.47 1.66 Eye (all) 1.21 2.17 only Aniridia 0.84 Cardiopulmonal 1.52 Gastrointestinal 0.68 Urogenital (all) 4.61 4.41 Cryptorchism 2.78 Hypospadia 1.78 Hair, skin, nails Hemihypertrophia 2.47 3.13 Neurofibromatosis 0.10 Bürger D, Feickert HJ, Mildenberger H: Current status of nephroblastoma treatment. Monogr Paediatr 18:224-242, 1986 Copyright Prof. Dr. Graf, Homburg
Syndromes und congenital Anomalities in Association with Wilms´ Tumor Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Nephroblastoma Neuroblastoma Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Sonography Copyright Prof. Dr. Graf, Homburg
CT Copyright Prof. Dr. Graf, Homburg
MRI Copyright Prof. Dr. Graf, Homburg
Bilateral nephroblastoma Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
SIOP 9 and SIOP 93-01 / GPOH tumor volume Copyright Prof. Dr. Graf, Homburg
SIOP 9 and SIOP 93-01 / GPOH low risk intermediate risk high risk 2000 1600 1200 800 400 after chemotherapy at diagnosis Tumor volume [ml] N = 51 470 85 mean 313 ml 434 ml 457 ml mean 166 ml 223 ml 423 ml P < 0.001 p < 0.001 n.s. 1200 800 400 N = 27 382 75 Copyright Prof. Dr. Graf, Homburg
SIOP 9 and SIOP 93-01 / GPOH low risk intermediate risk high risk 3000 P < 0.001 p < 0.001 mean 225 ml 215 ml 29 ml median 205 ml 152 ml 0 ml 2000 1000 Tumor volume reduction after preoperative chemotherapy [ml] low risk intermediate risk high risk -1000 -2000 N = 25 366 71 Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Operative Complications Obstruction of the gut and ileus 6.9 % Severe bleeding 5.9 % Wound infection 3.0 % Vessel injury 1.4 % Hernia 0.8 % Gut infarction 0.6 % Obstruction V. cava inferior 0.5 % Spleen injury 0.5 % Gut injury 0.5 % Pneumothorax 0.4 % Chylous ascites 0.4 % ML Ritchey et al.: Surgical Complications after Nephrectomy for Wilms´ Tumor. Surg Gynecol Obstet 175:507-514, 1992 Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
Stockholm Working Classification of Renal Tumours of Childhood Copyright Prof. Dr. Graf, Homburg
Tumor staging Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
SIOP 9 and SIOP 93-01 / GPOH preop. chemotherapy primary surgery % Copyright Prof. Dr. Graf, Homburg
Treatment schedule of the study SIOP 93-01 Copyright Prof. Dr. Graf, Homburg
multivariate analysis SIOP 9 / SIOP 93-01 multivariate analysis Copyright Prof. Dr. Graf, Homburg
Tumour volume and local stage SIOP 9 / SIOP 93-01 Tumour volume and local stage Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Chisq= 10.9 on 1 degrees of freedom, p= 0.000941 Survival according to treatment - correct / incorrect Chisq= 10.9 on 1 degrees of freedom, p= 0.000941 Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Copyright Prof. Dr. Graf, Homburg
Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Tumor volume after preoperative CT Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Tumor volume at diagnosis Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Mixed subtype, focal anaplasia Copyright Prof. Dr. Graf, Homburg
SIOP 9 / SIOP 93-01 Copyright Prof. Dr. Graf, Homburg