Is radiotherapy required in first-line treatment of stage I diffuse anaplastic Wilms tumor? A report of SIOP-RTSG, AIEOP, JWiTS, and UKCCSG
Fajardo, Raquel Dávila; van den Heuvel-Eibrink, Marry M.; van Tinteren, Harm; Spreafico, Filippo; Acha, Thomas; Bergeron, Christophe; de Camargo, Beatriz; Oldenburger, Foppe; Rübe, Christian; Oue, Takaharu; Vokuhl, Christian; de Krijger, Ronald R.; Vujanic, Gordan; Sebire, Neil; Coulomb-L'Hermine, Aurore; Collini, Paola; Gandola, Lorenza; Pritchard-Jones, Kathy; Graf, Norbert; Janssens, Geert O.; van Grotel, Martine
(2020) Pediatric Blood and Cancer, volume 67, issue 2
(Article)
Abstract
Background: As a significant proportion of relapses occurred in the tumor bed or abdomen on patients with the fifth National Wilms Tumor Study stage I anaplastic Wilms tumor (WT), flank radiotherapy was added for stage I anaplastic WT in the subsequent study of the Children's Oncology Group (AREN0321). Preliminary results
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revealed reduction of relapse rate and improved survival. In cases treated with preoperative chemotherapy, such as in International Society of Pediatric Oncology (SIOP), the value of radiotherapy has never been studied. The aim of this observational study is to describe the pattern of recurrence and survival of patients with stage I diffuse anaplastic WT (DAWT) after induction chemotherapy. Methods: Retrospective data analysis of the pattern of relapse and survival of all patients with stage I DAWT were included in recent SIOP, L'Associazone Italiana Ematologica Oncologia Pediatrica (AIEOP), Japan Wilms Tumor Study Group (JWiTS), United Kingdom Children's Cancer Study Group (UKCCSG) renal tumor registries. Postoperative treatment consisted of actinomycin D, vincristine, and doxorubicin for 28 weeks without local irradiation. Results: One hundred nine cases with stage I DAWT were identified, of which 95 cases received preoperative chemotherapy. Of these, seven patients underwent preoperative true-cut biopsy. Sixteen of the 95 patients relapsed (17%), six locally, four at distant site, and six combined, and all treated according to SIOP 2001 relapse protocol, which resulted in a 5-year overall survival of 93%. Conclusion: Despite 13% locoregional relapse rate, an excellent rescue rate was achieved after salvage treatment, in patients with stage I DAWT whose first-line treatment comprised three-drug chemotherapy (including doxorubicin), without flank irradiation. Therefore, we continue not to advocate the use of radiotherapy in first-line treatment after preoperative chemotherapy in stage I DAWT in the next SIOP protocol.
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Keywords: diffuse anaplasia, radiotherapy, stage I, Wilms tumor, Hematology, Oncology, Pediatrics, Perinatology, and Child Health, Journal Article
ISSN: 1545-5009
Publisher: Wiley-Liss Inc.
Note: Funding Information: We dedicate this work to Prof. I. Leuschner who has contributed tremendously to the development and activities of the pathology review group of the SIOP-RTSG. Prof. I. Leuschner unfortunately passed away on January 29, 2017. 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 Leukemia Group (which supported the UK section), Société Française des Cancers de l'Enfant and Association Leon Berard Enfant Cancéreux and Enfant et Santé (which supported the French section), Gesellschaft für Pädiatrische Onkologie und Hämatologie and Deutsche Krebschilfe (grant 50-2709-Gr2, which supported the German section), Grupo Cooperativo Brasileiro para o Tratamento do Tumor de Wilms and Sociedade Brasileira de Oncologia Pediátrica (which supported the Brazilian section), the Spanish Society of Pediatric Haematology and Oncology and the Spanish Association Against Cancer (which supported the Spanish section), and SIOP-NL. KP-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 centers in this study from 28 countries who enrolled and followed up patients in this study, and the patients and their families for their participation. 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 Leukemia Group (which supported the UK section), Société Française des Cancers de l'Enfant and Association Leon Berard Enfant Cancéreux and Enfant et Santé (which supported the French section), Gesellschaft für Pädiatrische Onkologie und Hämatologie and Deutsche Krebschilfe (grant 50‐2709‐Gr2, which supported the German section), Grupo Cooperativo Brasileiro para o Tratamento do Tumor de Wilms and Sociedade Brasileira de Oncologia Pediátrica (which supported the Brazilian section), the Spanish Society of Pediatric Haematology and Oncology and the Spanish Association Against Cancer (which supported the Spanish section), and SIOP‐NL. KP‐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 centers in this study from 28 countries who enrolled and followed up patients in this study, and the patients and their families for their participation. Publisher Copyright: © 2019 Wiley Periodicals, Inc.
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