letter to the Editor: Staging Designation for Bilateral Wilms'
Drs. Pritchard and Ransley believe the designation of stage V for children with bilateral Wilms' tumors may at times be confusing to pediatricians and parents.
Perhaps this is so, and a new designation is needed. We would not favor stage IIIb, however. This might cause more, not less, confusion. For example, how would a patient with bilateral tumors and pulmonary metastases at diagnosis be staged? What if the tumor on one side were to have positive lymph nodes and the other not? Would a patient who had all gross tumor removed at the time of initial surgery still be stage IIIb?
There are many possible combinations of disease extent at the time of diagnosis, as well as after initial surgery. We believe there is merit in having a single designation for these children. It is important to have an accurate denominator to sort out the possible association of bilateral disease with subsequent events. It is well known, for example, that second malignant neoplasms occur more frequently in patients with the genetic form of retinoblastoma. Important denominator information would be lost if children with bilateral kidney tumors were to be so identified only because there was gross Tumors residual disease after surgery, as is suggested in the stage 111 designation of Pritchard and Ransley .
Perhaps stage b (for "bilateral") would satisfy Drs. Pritchard and Ransley or should "stage" be dropped entirely, and the entry simply be "bilateral Wilms' tumors at diagnosis"?