NWTS

Twenty-two patients underwent primary liver resections (18 wedge resections and 4 lobectomies). After chemotherapy and/or radiation therapy, 13 patients underwent liver resections (7 wedge resections, 5 lobectomies, and 1 trisegmentectomy).

Seventy-one patients (67%) did not undergo surgery for their liver disease. In 14 patients, the liver disease responded completely to chemotherapy alone.

Eighty-two patients received abdominal radiation therapy.

The EFS rate was 75% for patients with metastatic FH Wilms tumor. For patients with lung-only metastases (n = 513), the EFS rate was 76%. For patients with liver metastases without lung metastases (n = 34), the EFS rate was 76%. The EFS rate was 70% (n = 62) for patients with both liver and lung metastases, compared with 64% for patients (n = 25) with other sites of metastases. There were no significant differences between the stage IV groups of patients (P = .60).

The EFS rate was 86% for patients who underwent primary resection of the liver metastases (n = 22), compared with 68% for patients who did not have a primary resection of the liver metastases (P = .09).

No significant difference in EFS was observed for patients treated with chemotherapy alone compared with patients treated with chemotherapy and radiation therapy (P = .63). The EFS rates were 64% for patients who did not receive abdominal radiation therapy, 77% for patients who received abdominal radiation therapy without a boost, and 72% for patients who received abdominal radiation therapy with a boost (P = .05).

Adult patients comprised part of the study population (<10% were older than 12 years and 3% were older than 16 years).

Based on these data, the authors concluded that liver metastasis at diagnosis is not an independent adverse prognostic factor for patients with stage IV disease. They also suggested that there is no reason to perform hepatic resection in the up-front setting. These two studies occurred between the 1960s and 1990s. During this time, hepatic resection techniques and approaches changed based on a better understanding of the liver anatomy. Furthermore, contemporary risk stratification approaches that include tumor cytogenetics were not evaluated in these studies nor were more conventional radiation techniques such as IMRT, which has the potential to provide better protection to normal tissues.[287]