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Randomized Controlled Trial
. 2014 Jan;61(1):134-9.
doi: 10.1002/pbc.24658. Epub 2013 Aug 23.

Outcome of patients with Stage II/favorable histology Wilms tumor with and without local tumor spill: a report from the National Wilms Tumor Study Group

Daniel M Green  1 , Norman E Breslow, Giulio J D'Angio, Marcio H Malogolowkin, Michael L Ritchey, Audrey E Evans, J Bruce Beckwith, Elizabeth J Perlman, Robert C Shamberger, Susan Peterson, Paul E Grundy, Jeffrey S Dome, Patrick R M Thomas, John A Kalapurakal
Affiliations
Randomized Controlled Trial

Outcome of patients with Stage II/favorable histology Wilms tumor with and without local tumor spill: a report from the National Wilms Tumor Study Group

Daniel M Green et al. Pediatr Blood Cancer. 2014 Jan.

Abstract

Background: Intra-operative tumor spill increases the risk of local recurrence of Wilms tumor, and adversely impacts relapse-free (RFS) and overall survival (OS) rates.

Methods: Surgical checklists, operative notes, institutional pathology reports, central pathology review and flow sheets of 602 patients registered between August 1986 and September 1994 on National Wilms Tumor Study-4 as randomized, followed or switched and coded as Final Stage II, favorable histology (FH) were reviewed. RFS and OS were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were estimated using the Cox model and tested for statistical significance by the log-rank test.

Results: Four hundred ninety-nine patients were found after review to have Stage II, FH Wilms tumor. The 8-year RFS percentages were 85.0% (95% confidence interval (CI): 81.1%, 88.1%) for those with no spill compared to 75.7% (65.8%, 83.2%) for those with spill. The 8-year OS percentages were 95.6% (93.1%, 97.3%) for those with no spill compared to 90.3% (82.2%, 94.9%) for those with spill. The HR for relapse among those with spill was 1.55 ((95%CI: 0.97,2.51), P = 0.067) and the HR for death was 1.94 ((0.92,4.09), P = 0.077).

Conclusions: RFS and OS were lower for patients who had intra-operative tumor spill. The majority of NWTS Stage II, FH patients with intra-operative tumor spill have an overall excellent outcome when treated with two drug chemotherapy (vincristine and actinomycin D) and no abdominal irradiation.

Keywords: Wilms tumor; actinomycin D; doxorubicin; oncology; radiation therapy; vincristine.

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Figures

Figure 1
Figure 1
A) Relapse-free survival of NWTS-4 stage II, favorable histology patients with and without spill; B) Overall survival of NWTS-4 stage II, favorable histology patients with and without spill
Figure 2
Figure 2
A) Local, metastatic and death event-free survival of NWTS-4 stage II, favorable histology patients with spill; B) Local, metastatic and death event-free survival of NWTS-4 stage II, favorable histology patients without spill
See this image and copyright information in PMC

References

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