Severe hepatopathy in National Wilms Tumor Studies 3-5: prevalence, clinical features, and outcomes after reintroduction of chemotherapy

The clinical impact of reintroduction of chemotherapy for children with renal tumors after an episode of treatment-related severe hepatopathy (SH) is not clear. In a cohort of 8,862 children with renal tumors treated according to National Wilms Tumor Study protocols 3-5, the incidence of SH was low (0.8%). Chemotherapy was continued or reintroduced in 85% of patients with SH, 72% of whom had no recurrence of any hepatopathy, and no patients who resumed chemotherapy after SH died of liver toxicity. The majority of children who restarted chemotherapy achieved resumption of full dosing by the end of therapy, and outcomes of patients with delays or dose reductions were not worse than those without modifications. The authors conclude that careful reintroduction of chemotherapy appeared to be feasible for the majority of patients who developed severe chemotherapy- and/or radiotherapy-induced liver toxicity.