Second, Peculiar Recurrence of a Wilms Tumor - Pleural And Late

Nephroblastoma (Wilms tumour) is the most common kidney malignancy in children and one of the most frequent abdominal tumours diagnosed in pediatric patients. We present the case of a 2-year-old boy diagnosed with intermediate-risk, regressive-type nephroblastoma of the left kidney in 2010. He was treated with neoadjuvant chemotherapy followed by surgery and chemotherapy (following the International Society of Pediatric Oncology- SIOP protocol). After 11 months a metastasis was discovered in the left lungand the patient was (re)classified as being high risk and treated with seven cyclesof chemotherapy. After nine disease-free years, the routine follow-up chest CT scan showed a 10/5cm tumor in the left lung involving the pleura. The tumor was completely resected, and pathology confirmed a distal recurrence of nephroblastoma. The patient was further treated according to the UMBRELLA protocol (BB group) with chemotherapy and local irradiation. The tumor bed was irradiated with 25.2 Gy/14 fr, using Helical Tomotherapy. Following radiotherapy, hereceived a high dose chemotherapy and autollogus stem-cell transplant, with a good response and without disease recurrence.