Radiation therapy for favorable histology Wilms tumor: prevention of flank recurrence did not improve survival on National Wilms Tumor Studies 3 and 4.

Abstract

PURPOSE:

To determine whether radiation therapy (RT) of patients with Wilms tumor of favorable histology prevented flank recurrence and thereby improved the survival outcomes.

METHODS AND MATERIALS:

Recurrence and mortality risks were compared among groups of patients with Stage I-IV/favorable histology Wilms tumor enrolled in the third (n = 1,640) and fourth (n = 2,066) National Wilms Tumor Study Group studies.

RESULTS:

Proportions of patients with flank recurrence were 0 of 513 = 0.0% for 20 Gy, 12 of 805 = 1.5% for 10 Gy, and 44 of 2,388 = 1.8% for no flank RT (p trend = 0.001 adjusted for stage and doxorubicin); for intra-abdominal (including flank) recurrence they were 5 of 513 = 1.0%, 30 of 805 = 3.7%, and 58 of 2,388 = 2.4%, respectively (p trend = 0.02 adjusted). Survival percentages at 8 years after intra-abdominal recurrence were 0 of 5 = 0% for 20 Gy, 10 of 30 = 33% for 10 Gy, and 34 of 58 = 56% for no RT (p trend = 0.0001). NWTS-4 discontinued use of 20 Gy RT, and the 8-year flank recurrence risk increased to 2.1% from 1.0% on NWTS-3 (p = 0.013). However, event-free survival was unaltered (88% vs. 86%, p = 0.39), and overall survival was better (93.8% vs. 90.8%, p = 0.036) on NWTS-4.

CONCLUSIONS:

Partly because of lower postrecurrence mortality among nonirradiated patients, prevention of flank recurrence by RT did not improve survival. It is important to evaluate entire treatment policies with regard to long-term outcomes.

• Authors: Norman E Breslow, J Bruce Beckwith, Gerald M Haase, John A Kalapurakal, Michael L Ritchey, Robert C Shamberger, Patrick R M Thomas, Giulio J D'Angio, Daniel M Green
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 65 Issue 1 Pg. 203-9 (May 01 2006) ISSN: 0360-3016 [Print] United States
• PMID: 16542795 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Antibiotics, Antineoplastic
• Doxorubicin

Topics

• Adolescent
• Antibiotics, Antineoplastic (therapeutic use)
• Child
• Doxorubicin (therapeutic use)
• Female
• Humans
• Kidney Neoplasms (mortality, pathology, prevention & control, radiotherapy)
• Male
• Neoplasm Recurrence, Local (mortality, prevention & control)
• Neoplasm Staging
• Radiotherapy Dosage
• Rhabdoid Tumor
• Risk
• Sarcoma, Clear Cell
• Wilms Tumor (mortality, pathology, prevention & control, radiotherapy)