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Is radiotherapy required in first‐line treatment of stage I diffuse anaplastic Wilms tumor? A report of SIOP‐RTSG, AIEOP, JWiTS, and UKCCSG
Author(s) -
Fajardo Raquel Dávila,
den HeuvelEibrink Marry M.,
Tinteren Harm,
Spreafico Filippo,
Acha Thomas,
Bergeron Christophe,
Camargo Beatriz,
Oldenburger Foppe,
Rübe Christian,
Oue Takaharu,
Vokuhl Christian,
Krijger Ronald R.,
Vujanic Gordan,
Sebire Neil,
CoulombL'Hermine Aurore,
Collini Paola,
Gandola Lorenza,
PritchardJones Kathy,
Graf Norbert,
Janssens Geert O.,
Grotel Martine
Publication year - 2020
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28039
Subject(s) - medicine , wilms' tumor , vincristine , radiation therapy , stage (stratigraphy) , chemotherapy , surgery , biopsy , survival rate , oncology , cyclophosphamide , paleontology , biology
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 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.