Original Research

Post-treatment surveillance abdominopelvic computed tomography in children with Wilms tumour: Is it worth the risk?

Jacobus H. Otto, Jacques Janse van Rensburg, David K. Stones
South African Journal of Radiology | Vol 19, No 1 | a784 | DOI: https://doi.org/10.4102/sajr.v19i1.784 | © 2015 Jacobus H. Otto, Jacques Janse van Rensburg, David K. Stones | This work is licensed under CC Attribution 4.0
Submitted: 02 February 2015 | Published: 05 August 2015

About the author(s)

Jacobus H. Otto, Department of Clinical Imaging Sciences, University of the Free State, South Africa
Jacques Janse van Rensburg, Department of Clinical Imaging Sciences, University of the Free State, South Africa
David K. Stones, Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Free State, South Africa


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Abstract

Background: Wilms tumour is a comparatively common paediatric malignancy with a relatively good prognosis. Routine post-treatment surveillance at our institution currently includes regular abdominopelvic computed tomography (CT) over a two-year period for the early detection of disease recurrence. The rationale is that early salvage therapy may improve overall patient survival, and thus justifies the exposure to potentially harmful ionising radiation.

Objective: To critically evaluate the routine use of post-treatment abdominopelvic CT by determining the detection rate of disease recurrence and associated clinical outcomes.

Methods: Sixty-four patients in remission following initial treatment for Wilms tumour were included in this retrospective study. Variables obtained from patient records included gender, age, histological grading and tumour stage at presentation, number of abdominopelvic CT scans, site(s) of relapse, method of recurrence detection and confirmation, time to recurrence and clinical outcome.

Results: The patients received a total of 334 surveillance abdominopelvic CT scans. Nine (14%) patients developed disease recurrence during the follow-up period. In three cases, the initial detection method was abdominopelvic CT. All three of these patients subsequently died despite salvage therapy (22 months median survival). Five false-positive diagnoses of recurrence occurred, with two being made on abdominopelvic CT.

Conclusion: Routine post-treatment abdominopelvic CT showed a low detection rate of disease recurrence in children treated for Wilms tumour, while subjecting patients to a large radiation burden. The recommendation is that current practice be changed in line with the ultrasound-based Société Internationale d’Oncologie Pédiatrique (SIOP) imaging guidelines.


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1. Relapse of Wilms' tumour and detection methods: a retrospective analysis of the 2001 Renal Tumour Study Group–International Society of Paediatric Oncology Wilms' tumour protocol database
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