Omission of adjuvant chemotherapy in patients with completely necrotic Wilms tumor stage I and radiotherapy in stage III: The 30-year SIOP-RTSG experience

被引:1
作者
Vujanic, Gordan M. [1 ,2 ]
Graf, Norbert [3 ]
D'Hooghe, Ellen [4 ]
Pritchard-Jones, Kathy [5 ]
Bergeron, Christophe [6 ]
van Tinteren, Harm [7 ]
Furtwaengler, Rhoikos [3 ,8 ]
机构
[1] Sidra Med, Dept Pathol, Luqta Str,POB 26999, Doha, Qatar
[2] Weill Cornell Med Qatar, Doha, Qatar
[3] Saarland Univ Hosp, Dept Hematol & Oncol, Homburg, Germany
[4] Oslo Univ Hosp, Dept Pathol, Rikshosp, Oslo, Norway
[5] UCL Great Ormond St Hosp, Inst Child Hlth, London, England
[6] Ctr Leon Berard, Inst Hematol & Oncol Pediat, Lyon, France
[7] Princess Maxima Ctr Pediat Oncol, Utrecht, Netherlands
[8] Inselspital Univ Hosp, Dept Pediat, Div Pediat Hematol & Oncol, Bern, Switzerland
关键词
completely necrotic type; radiotherapy; reduced treatment; Wilms tumor; INTERNATIONAL-SOCIETY; WORKING CLASSIFICATION; INTERMEDIATE-RISK; RENAL TUMORS; NEPHROBLASTOMA; CHILDREN; TRIAL; PATHOLOGY;
D O I
10.1002/pbc.30852
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BackgroundCompletely necrotic Wilms tumor (CN-WT) following preoperative chemotherapy has been regarded as low-risk WT since the International Society of Paediatric Oncology (SIOP) 93-01 study, and patients have been treated with reduced postoperative therapy. The aim of the study was to evaluate whether the omission of adjuvant chemotherapy in patients with localized CN-WT stage I and radiotherapy in stage III was safe.Patients and methodsThe retrospective observational study of outcomes of patients diagnosed with localized CN-WT on central pathology review and treated according to the SIOP 93-01 and SIOP-WT-2001 protocols (1993-2022).ResultsThere were 125 patients with localized CN-WT: 90 with stage I, 10 with stage II, and 25 with stage III. Sixty-two of 125 (49.6%) patients had a discrepant diagnosis and/or staging between the institutional pathologist and central pathology review. In the group of 90 patients with stage I, postoperative chemotherapy was not given to 41 (46%) patients, whereas 49 patients received postoperative chemotherapy-in the latter group, two patients relapsed, and one of them died. One stage I and one stage II patient developed chemotherapy-induced toxicity and died. Nineteen of 25 patients with stage III received no flank radiotherapy. No stage III patient relapsed or died. The overall 5-year event-free survival (EFS) estimate for the entire cohort (stages I-III) was 96.8% [95% confidence interval, CI: 93.6%-99.6%] and the overall survival (OS) was 97.6% [95% CI: 95.0-100%]. The EFS and OS were 97% and 98%, respectively, for stage I, and 100% for stage III.ConclusionOmission of postoperative chemotherapy for patients with CN-WT stage I, and radiotherapy for stage III is safe. Rapid central pathology review is required to assign appropriate treatment and avoid treatment-related side effects.
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页数:6
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