Renal cell carcinoma in children. Prognostic factors

OBJECTIVE: To determine the outcome in childhood renal cell carcinoma and the role of surgical and radiation treatment.

METHODS: The records of 21 children with renal cell carcinoma were reviewed, 15 patients treated in the University of Toronto centers from 1959 through to 1997 and 6 patients treated in King Faisal Specialist Hospital, Riyadh, Kingdom of Saudi Arabia from 1975 through to 1998. The age was 3-17 (median 13) years. Systematic metastases were present at diagnosis in 5 patients. Regional nodal spread was present in 9 patients and 7 patients had localized disease alone. In the 16 M0 patients, the surgical treatment was radical nephrectomy (14 patients) partial nephrectomy (one patient) and wedge resection (one patient). Postoperative radiation treatment was utilized in 8 (50%) of these patients.

RESULTS: The 5 year survival rate for all patients was 52%, and for M0 patients was 70%. No patient with systematic metastases at diagnosis survived beyond 26 months. Four of 7 node negative patients and 8 of 9 node positive patients remained in first complete remission, with the duration of follow up 1-30 (Median 5) years. Seven of 8 M0 patients who did not receive adjuvant radiation therapy continued in first remission (3N0, 2NI, 2N2), compared with 5 of 8 patients who received postoperativeradiation treatment (1 N0, 2 NI, 2 N2).

CONCLUSION: The prognosis of localized renal cell carcinoma in childhood may be better than in the adult. Gross complete resection is required for long term survival. Elective postoperativeradiation treatment is not indicated.