Outcome After Pulmonary Radiotherapy in Wilms' Tumor Patients With Pulmonary Metastases at Diagnosis: A UK Children's Cancer Study Group, Wilms' Tumour Working Group Study
| Autor: | Anna Kelsey, Chris Baughan, Rosemary S. Shannon, Kathy Pritchard-Jones, Donna Richardson, Suzanne Stevens, Roger E. Taylor, Gary Nicolin, Chris Mitchell |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Cancer Research medicine.medical_specialty Lung Neoplasms medicine.medical_treatment Wilms Tumor Disease-Free Survival Internal medicine Antineoplastic Combined Chemotherapy Protocols Confidence Intervals Humans Medicine Radiology Nuclear Medicine and imaging Child Neoplasm Staging Retrospective Studies Chemotherapy Radiation Lung business.industry Hazard ratio Infant Cancer Radiotherapy Dosage Refusal to Treat Wilms' tumor Retrospective cohort study medicine.disease Kidney Neoplasms Surgery Clinical trial Radiation therapy medicine.anatomical_structure Oncology Child Preschool Female Neoplasm Recurrence Local business Follow-Up Studies |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 70:175-180 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2007.05.053 |
| Popis: | Purpose To evaluate the effect of whole lung radiotherapy on event-free and overall survival of children with Stage IV Wilms' tumor with pulmonary metastases at diagnosis and to ascertain factors that may have led to the decision to withhold radiotherapy. Methods and Materials We compared recurrence and mortality risks of patients with pulmonary metastases at diagnosis enrolled in the UKW2 and UKW3 clinical trials (1986–2001) according to treatment with pulmonary radiotherapy. Results Of 102 eligible patients (43 patients in UKW2 and 59 patients in UKW3), 72 (71%) received pulmonary radiotherapy; 30 (29%) did not. After a median follow-up of 9.3 years (range, 0.6–14.1 years), event-free survival was 79.2% (95% confidence interval [CI], 67.8–86.9%) in patients who received pulmonary radiotherapy compared with 53.3% (95% CI, 34.3–69.1%) in patients who did not receive it ( p = 0.006), with a hazard ratio of 2.66 (95% CI, 1.28–5.52; p = 0.009). There was no difference in overall survival (84.7% [95% CI, 74.1–91.2%] vs. 73.2% [95% CI, 53.4–85.6%], respectively; p = 0.157). Pulmonary radiotherapy reduced the chance of lung relapse (8.3% vs. 23.3%; p = 0.039). The omission of radiotherapy did not seem to be consistently associated with any specific clinical or radiologic features. Conclusions Outcome may be compromised if pulmonary radiotherapy is omitted in children with Wilms' tumor with pulmonary metastases. There was a significant effect on event-free survival; the risk of an event, particularly lung recurrence, was increased nearly threefold. Strategies for selection of children for avoidance of pulmonary irradiation need to be developed in a controlled fashion. |
| Databáze: | OpenAIRE |
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