Influence of chemotherapy on apoptosis and necrosis of Wilms' tumor cells

Objective The aim of study is to investigate the influence of chemotherapy on apoptosis and necrosis in Wilms' tumor. Methods From 1990 to 1998, 44 children with Wilms' tumor were randomized into two groups. Group A ( n =26) underwent preoperative chemotherapy with Dacinomycine, Vincrinstine and Cyclophosphamide. Eight of them had additional chemo-embolization with iodized oil and Adramycin via renal artery. Group B ( n =18) underwent nephrectomy followed by chemotherapy. Utilizing the technique of TUNEL and routine pathological methods, the status of apoptosis and necrosis were determined in all specimens. Results The Apoptotic Index (AI) of group A was significantly higher than that of group B ( P 0.05 ). Within group-A patients, AIs of those who had more than 14 days of chemotherapy were higher than the AI of those less than 14 days. The AIs between those who died and those who survived for two or more years, between those who had additional chemo-embolization and those who did not, between those diagnosed as FH and as UH, were not statistically significant. The difference in rates of complete tumor necrosis were statistically significant between group A and group B patients ( P 0.05 ). The difference between those who had additional chemo-embolization and those who had not was also statistically significant ( P 0.05 ). Conclusions Chemotherapy can produce significant apoptosis and necrosis in Wilms' tumors. Preoperative chemotherapy and additional chemo-embolization can lead to more necrosis. AI of Wilms' tumor may not be as a prognostic factor but can be used as an indicator of the efficacy of chemotherapy.