Evaluation of boost irradiation in patients with intermediate-risk stage III Wilms tumour with positive lymph nodes only: Results from the SIOP-WT-2001 Registry
Dávila Fajardo, Raquel; Oldenburger, Eva; Rübe, Christian; López-Yurda, Marta; Pritchard-Jones, Kathy; Bergeron, Christophe; Graf, Norbert; van Grotel, Martine; van Tinteren, Harm; Saunders, Daniel; van den Heuvel-Eibrink, Marry M.; Janssens, Geert O.; Oldenburger, Foppe
(2018) Pediatric Blood and Cancer, volume 65, issue 8
(Article)
Abstract
Objective: To evaluate the value of radiotherapy boost omission in patients with intermediate-risk, stage III Wilms tumours (WT) with positive lymph nodes (LN). Methods and materials: All patients with intermediate-risk, stage III (LN positive) WT consecutively registered in the SIOP-WT-2001 study were included in this analysis. Endpoints were 5-year event-free
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survival (EFS), loco-regional control (LRC) and overall survival (OS). Results: Between June 2001 and May 2015, 2,569 patients with stage I to III WT after preoperative chemotherapy were registered in the SIOP-WT-2001 study. Five hundred and twenty-three (20%) had stage III disease, of which 113 patients had stage III due to positive LN only. Of those, 101 (89%) received radiotherapy, 36 of which (36%) received, apart from flank irradiation, a boost dose to the LN positive area. Four patients (4%) did not receive any adjuvant radiotherapy. In eight patients information on radiotherapy was not available. With a median follow-up of 71 months, no difference in 5-year EFS (84% vs. 83%, P = 0.77) and LRC (96% vs. 97%, P = 0.91) was observed between patients receiving a radiotherapy boost and those without boost, respectively. Five-year OS, including salvage therapy, was excellent (boost vs. no boost: 97% vs. 95%, P = 0.58). Conclusions: Outcome data demonstrate that omission of the radiotherapy boost to the loco-regional positive lymph nodes in patients with intermediate-risk, stage III WT who receive preoperative chemotherapy and postoperative flank irradiation (14.4 Gy) can be considered a safe approach for future SIOP protocols.
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Keywords: boost, intermediate risk, lymph node, radiotherapy, Wilms tumour, Pediatrics, Perinatology, and Child Health, Hematology, Oncology
ISSN: 1545-5009
Publisher: Wiley-Liss Inc.
Note: Funding Information: The SIOP WT 2001 study was funded by Cancer Research UK (grant C1188/A8687), the UK National Cancer Research Network and Children's Cancer and Leukaemia Group (CCLG) (who supported the UK section), Société Française des Cancers de l'Enfant and Association Leon Berard Enfant Cancéreux and Enfant et Santé (who supported the French section), Gesellschaft für Pädiatrische Onkologie und Häma-tologie and Deutsche Krebschilfe (grant 50-2709-Gr2, who supported the German section), Grupo Cooperativo Brasileiro para o Tratamento do Tumor de Wilms and Sociedade Brasileira de Oncologia Pediátrica (who supported the Brazilian section), the Spanish Society of Pediatric Haematology and Oncology and the Spanish Association Against Cancer (who supported the Spanish section) and SIOP-NL. K.P.-J. is partly supported by the National Institute for Health Research Biomedical Research Centre Funding Scheme. Funding Information: The SIOP WT 2001 study was funded by Cancer Research UK (grant C1188/A8687), the UK National Cancer Research Network and Children's Cancer and Leukaemia Group (CCLG) (who supported the UK section), Société Française des Cancers de l'Enfant and Association Leon Berard Enfant Cancéreux and Enfant et Santé (who supported the French section), Gesellschaft für Pädiatrische Onkologie und Häma-tologie and Deutsche Krebschilfe (grant 50-2709-Gr2, who supported the German section), Grupo Cooperativo Brasileiro para o Tratamento do Tumor de Wilms and Sociedade Brasileira de Oncologia Pediátrica (who supported the Brazilian section), the Spanish Society of Pediatric Haematology and Oncology and the Spanish Association Against Cancer (who supported the Spanish section) and SIOP-NL. K.P.-J. is partly supported by the National Institute for Health Research Biomedical Research Centre Funding Scheme. We acknowledge the enormous efforts made by more than 1000 clinicians working at the 251 childhood cancer treatment centres in this study from 28 countries who enrolled and followed up patients in this study and the patients and their families for their participation. The SIOP Renal Tumours Study Group and all authors thank the members of the independent data monitoring committee: Max Coppes (British Columbia Cancer Agency, Funding Information: The SIOP WT 2001 study was funded by Cancer Research UK (grant C1188/A8687), the UK National Cancer Research Network and Children's Cancer and Leukaemia Group (CCLG) (who supported the UK section), Soci?t? Fran?aise des Cancers de l'Enfant and Association Leon Berard Enfant Canc?reux and Enfant et Sant? (who supported the French section), Gesellschaft f?r P?diatrische Onkologie und H?matologie and Deutsche Krebschilfe (grant 50-2709-Gr2, who supported the German section), Grupo Cooperativo Brasileiro para o Tratamento do Tumor de Wilms and Sociedade Brasileira de Oncologia Pedi?trica (who supported the Brazilian section), the Spanish Society of Pediatric Haematology and Oncology and the Spanish Association Against Cancer (who supported the Spanish section) and SIOP-NL. K.P.-J. is partly supported by the National Institute for Health Research Biomedical Research Centre Funding Scheme. We acknowledge the enormous efforts made by more than 1000 clinicians working at the 251 childhood cancer treatment centres in this study from 28 countries who enrolled and followed up patients in this study and the patients and their families for their participation. The SIOP Renal Tumours Study Group and all authors thank the members of the independent data monitoring committee: Max Coppes (British Columbia Cancer Agency, Canada), Otilia Dalesio (Netherlands Cancer Institute, Amsterdam) and Dietmar Schmidt (Mannheim, Germany). The SIOP WT 2001 study was funded by Cancer Research UK (grant C1188/A8687), the UK National Cancer Research Network and Children's Cancer and Leukaemia Group (CCLG) (who supported the UK section), Soci?t? Fran?aise des Cancers de l'Enfant and Association Leon Berard Enfant Canc?reux and Enfant et Sant? (who supported the French section), Gesellschaft f?r P?diatrische Onkologie und H?matologie and Deutsche Krebschilfe (grant 50-2709-Gr2, who supported the German section), Grupo Cooperativo Brasileiro para o Tratamento do Tumor de Wilms and Sociedade Brasileira de Oncologia Pedi?trica (who supported the Brazilian section), the Spanish Society of Pediatric Haematology and Oncology and the Spanish Association Against Cancer (who supported the Spanish section) and SIOP-NL. K.P.-J. is partly supported by the National Institute for Health Research Biomedical Research Centre Funding Scheme. Publisher Copyright: © 2018 Wiley Periodicals, Inc.
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