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Renal Tumors

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Pediatric Surgery

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Abstract

Background: The Children’s Oncology Group (COG) Renal Tumor (RT) Biology and Risk Stratification Protocol incorporates real-time central review to direct risk stratification and enrollment on COG therapeutic studies. We assessed the feasibility of the real-time central review process and its impact on the accuracy of risk stratification. Methods: 3,000 patients were enrolled on AREN03B2 between February 2006 and January 2012, with submissions from 214 COG institutions. Eligible diagnoses included any RT and extra-renal Wilms’ tumor or non-CNS rhabdoid tumor. Enrollment on AREN03B2 was required to enroll on an RT treatment study. Submission of pathology slides, radiology images, operative reports, and tumor and blood for analysis was required within 7 days of surgery to meet enrollment deadlines stipulated by the therapeutic studies. Central pathology review for histology and stage, radiology review for presence of bilateral lesions and pulmonary metastases, and surgical review for operative stage were completed electronically by a panel of expert reviewers. An initial risk assignment (IRA) was made by the study chairs based on the multidisciplinary central reviews. Results: 2,913/3,000 met all eligibility and submission requirements. The median time from enrollment to IRA was 8 days. 1,205 discrepancies between central and institutional review potentially impacting IRAs were observed; including differences in initial histology in 253 unilateral and 69 bilateral tumors, pathologic staging of 294 tumors, diagnostic imaging of 92 bilateral cases and 112 cases of pulmonary metastases, and the surgical review of 244 cases of rupture and 141 instances of node sampling. Conclusion: Real-time central review is feasible in a large multicenter study. Discrepancies between local and central risk stratification were identified in a substantial number of participants. Communication of these findings in real time supported increased accuracy of enrollment on appropriate clinical trials and strengthened the comprehensive annotation of a rich RT biorepository. Expansion of this process to other pediatric tumor registry protocols should be strongly considered. © 2014 by American Society of Clinical Oncology OPTIONS & TOOLS

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Acknowledgments

This chapter has been adapted from the author’s own chapters in the following publications: Ashcraft’s Pediatric Surgery (Fifth Edition) edited by George Whitfield Holcomb, III, J. Patrick Murphy, and Daniel J. Ostlie. Copyright © 2010 Elsevier Inc. and Hamilton T.E., Shamberger R.C. (2016) Renal Tumors. In: Carachi R., Grosfeld J. (eds) The Surgery of Childhood Tumors. Springer, Berlin, Heidelberg.

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    Thomas E. Hamilton & Robert C. Shamberger

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    Prem Puri

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Hamilton, T.E., Shamberger, R.C. (2020). Renal Tumors. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_147-1

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