What Every Pediatric Surgeon Should Know About Common Systemic Therapies for the Treatment of Renal Tumors in Children and Adolescents

Introduction: Renal tumors are among the most common solid pediatric malignancies. The mainstay of treatment is surgical intervention, with chemotherapy and radiation given according to risk stratification schemes. Given the potential for surgery and chemotherapy to occur in proximity, it is important for surgeons to understand the impact of these systemic therapies. The purpose of this review is to provide a comprehensive overview for pediatric surgeons of the most common chemotherapeutic agents and targeted therapies utilized in the treatment of pediatric renal malignancies. Methods: A literature search was conducted for the mechanism of action, indications, and surgical considerations for the following chemotherapeutic agents and targeted therapies, which comprise the drugs used in the treatment of children and adolescents with renal tumors: vincristine, actinomycin D, doxorubicin, cyclophosphamide, carboplatin, etoposide, irinotecan, topotecan, nivolumab, axitinib, tazemetostat, everolimus, and bevacizumab. Findings: As expected, the most common side effects that warrant careful consideration in surgical planning include myelosuppression, impacting wound healing and bleeding risks, and solid organ toxicities including cardiac, renal, hepatic and pulmonary toxicities. The incidence and severity of these complications varies across therapies, and timing of expected recovery varies as well. Conclusions: This review provides a comprehensive overview of 11 systemic therapies utilized in the treatment of pediatric renal malignancies. It is intended to serve as a tool for surgeons to provide a holistic approach to patient care, and better plan surgical procedures to ensure the greatest efficacy and safety profile. Level of Evidence: level IV.