Treatment of stage I anaplastic Wilms' tumour: a report from the Children's Oncology Group AREN0321 study.
Adolescent
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Chemotherapy, Adjuvant
Child
Child, Preschool
Dactinomycin
/ administration & dosage
Disease Progression
Doxorubicin
/ administration & dosage
Female
Humans
Infant
Kidney Neoplasms
/ mortality
Male
Neoplasm Staging
Nephrectomy
Progression-Free Survival
Radiotherapy, Adjuvant
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
United States
Vincristine
/ administration & dosage
Wilms Tumor
/ mortality
Dactinomycin
Diffuse anaplasia
Doxorubicin
Focal anaplasia
Outcome
Radiation
Stage I
Treatment
Vincristine
Wilms tumour
Journal
European journal of cancer (Oxford, England : 1990)
ISSN: 1879-0852
Titre abrégé: Eur J Cancer
Pays: England
ID NLM: 9005373
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
27
01
2019
revised:
30
03
2019
accepted:
22
05
2019
pubmed:
22
7
2019
medline:
9
6
2020
entrez:
21
7
2019
Statut:
ppublish
Résumé
In the fifth National Wilms Tumor Study (NWTS-5), the 4-year event-free survival (EFS) and overall survival (OS) estimates for 29 patients with stage I focal (n = 10) or diffuse (n = 19) anaplastic Wilms' tumour (AWT) treated with vincristine and dactinomycin without flank radiation were 69.5% and 82.6%, respectively. The Children's Oncology Group AREN0321 study evaluated whether adding doxorubicin and flank radiation improves survival for these patients. Tumour histology and stage were confirmed by real-time central pathology, surgery and radiology review. The patients received 25 weeks of vincristine, dactinomycin and doxorubicin (cumulative dose 150 mg/m Eighteen patients with stage I AWT (8 focal and 10 diffuse) were enrolled on AREN0321. With a median follow-up of 4.6 years, the 4-year EFS and OS were 100%. One patient with diffuse AWT had pulmonary relapse 4.12 years after diagnosis. In the 112 patients with stage I AWT treated in NWTSs 1-5 and AREN0321, the EFS was significantly improved with doxorubicin treatment (p = 0.01; 4-year EFS: 97.2% [95% confidence interval {CI}: 91.3-100] vs. 77.5% [95% CI: 67.6-87.4]) but not by flank radiation (p = 0.15). Treatment of stage I AWT with vincristine, dactinomycin, doxorubicin and flank radiation in AREN0321 yielded excellent survival outcomes. Retrospective analysis of AREN0321 and NWTS patients suggests that doxorubicin had a greater contribution to the excellent outcomes than radiation.
Sections du résumé
BACKGROUND
In the fifth National Wilms Tumor Study (NWTS-5), the 4-year event-free survival (EFS) and overall survival (OS) estimates for 29 patients with stage I focal (n = 10) or diffuse (n = 19) anaplastic Wilms' tumour (AWT) treated with vincristine and dactinomycin without flank radiation were 69.5% and 82.6%, respectively. The Children's Oncology Group AREN0321 study evaluated whether adding doxorubicin and flank radiation improves survival for these patients.
PATIENTS AND METHODS
Tumour histology and stage were confirmed by real-time central pathology, surgery and radiology review. The patients received 25 weeks of vincristine, dactinomycin and doxorubicin (cumulative dose 150 mg/m
RESULTS
Eighteen patients with stage I AWT (8 focal and 10 diffuse) were enrolled on AREN0321. With a median follow-up of 4.6 years, the 4-year EFS and OS were 100%. One patient with diffuse AWT had pulmonary relapse 4.12 years after diagnosis. In the 112 patients with stage I AWT treated in NWTSs 1-5 and AREN0321, the EFS was significantly improved with doxorubicin treatment (p = 0.01; 4-year EFS: 97.2% [95% confidence interval {CI}: 91.3-100] vs. 77.5% [95% CI: 67.6-87.4]) but not by flank radiation (p = 0.15).
CONCLUSIONS
Treatment of stage I AWT with vincristine, dactinomycin, doxorubicin and flank radiation in AREN0321 yielded excellent survival outcomes. Retrospective analysis of AREN0321 and NWTS patients suggests that doxorubicin had a greater contribution to the excellent outcomes than radiation.
Identifiants
pubmed: 31325873
pii: S0959-8049(19)30361-2
doi: 10.1016/j.ejca.2019.05.033
pmc: PMC6690766
mid: NIHMS1535010
pii:
doi:
Substances chimiques
Dactinomycin
1CC1JFE158
Vincristine
5J49Q6B70F
Doxorubicin
80168379AG
Types de publication
Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
58-66Subventions
Organisme : NCI NIH HHS
ID : U10 CA098413
Pays : United States
Organisme : NCI NIH HHS
ID : U24 CA114766
Pays : United States
Organisme : NCI NIH HHS
ID : U10 CA098543
Pays : United States
Organisme : NCI NIH HHS
ID : U10 CA180899
Pays : United States
Organisme : NCI NIH HHS
ID : U10 CA180886
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Ltd. All rights reserved.
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