Radiation therapy for favorable histology Wilms tumor: Prevention of flank recurrence did not improve survival on National Wilms Tumor Studies 3 and 4
- Department of Biostatistics, University of Washington, Seattle, WA (United States) and Fred Hutchinson Cancer Research Center, Seattle, WA (United States)
- Department of Pathology, Loma Linda University, Loma Linda, CA (United States)
- Department of Pediatric Surgery, Denver Children's Hospital, Denver, CO (United States)
- Division of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL (United States)
- Division of Urology, University of Texas at Houston Health Science Center, Houston, TX (United States)
- Department of Surgery, Children's Hospital and Harvard Medical School, Boston, MA (United States)
- Department of Radiation Oncology, Bayfront Cancer Care Center, St. Petersburg, FL (United States)
- Department of Radiation Oncology, Hospital of University of Pennsylvania, Philadelphia, PA (United States)
- Department of Pediatrics, Roswell Park Cancer Institute, Buffalo, NY (United States)
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.
- OSTI ID:
- 20793476
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 65, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2005.11.029; PII: S0360-3016(05)02987-1; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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