RESECTION OF METASTASES IN WILMS' TUMOR: A REPORT OF THREE CASES CURED OF PULMONARY AND HEPATIC METASTASES

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Abstract
Three cases of Wilms' tumor metastatic to both the lungs and liver are described. The first case had pulmonary metastases on three occasions. The initial episode was treated with radiation, the second by excision, and the third by combined chemotherapy. The second case also had three recurrences of pulmonary metastases; the first two were treated by excision and the third was treated by radiation followed by excision of residual tumor. Pulmonary involvement occurred only once in the third case and was treated by combined radiation and actinomycin D. All three cases had hepatic metastases. Hepatic lobectomy was employed in two cases and radiation was used in a third. The apparent cure of these cases emphasizes the importance of vigorously applying the therapeutic modalities currently available. The frequent use of surgical excision in these cases was based upon three advantages of this modality: minimal damage to normal tissues, undiminished effectiveness on repeated use, and ability to discover metastases otherwise undetectable. The indications for resection for pulmonary metastases are discussed. Hepatic lobectomy, previously unreported in Wilms' tumor, would appear to merit more extensive use.

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