Raquel Dávila Fajardo1, Eva Oldenburger2, Christian Rübe3, Marta López-Yurda4, Kathy Pritchard-Jones5, Christophe Bergeron6, Norbert Graf7, Martine van Grotel8, Harm van Tinteren4, Daniel Saunders9, Marry M van den Heuvel-Eibrink8, Geert O Janssens1, Foppe Oldenburger10. 1. Department of Radiation Oncology, University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands. 2. Radiation Oncology Department, Leuven Cancer Center, Leuven, Belgium. 3. Department of Radio-Oncology, University Hospital of Saarland, Homburg, Germany. 4. Department of Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 5. Cancer Section, University College London Institute of Child Health, London, UK. 6. Department of Paediatric Oncology, Centre Leon Berard, Lyon, France. 7. Department of Paediatric Oncology, University Hospital of Saarland, Homburg, Germany. 8. Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands. 9. Department of Radiation Oncology. The Christie NHS Foundation Trust, The Christie NHS Foundation Trust, Manchester, UK. 10. Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands.
Abstract
OBJECTIVE: To evaluate the value of radiotherapy boost omission in patients with intermediate-risk, stage III Wilms tumours (WT) with positive lymph nodes (LN). METHODS AND MATERIALS: All patients with intermediate-risk, stage III (LN positive) WT consecutively registered in the SIOP-WT-2001 study were included in this analysis. Endpoints were 5-year event-free survival (EFS), loco-regional control (LRC) and overall survival (OS). RESULTS: Between June 2001 and May 2015, 2,569 patients with stage I to III WT after preoperative chemotherapy were registered in the SIOP-WT-2001 study. Five hundred and twenty-three (20%) had stage III disease, of which 113 patients had stage III due to positive LN only. Of those, 101 (89%) received radiotherapy, 36 of which (36%) received, apart from flank irradiation, a boost dose to the LN positive area. Four patients (4%) did not receive any adjuvant radiotherapy. In eight patients information on radiotherapy was not available. With a median follow-up of 71 months, no difference in 5-year EFS (84% vs. 83%, P = 0.77) and LRC (96% vs. 97%, P = 0.91) was observed between patients receiving a radiotherapy boost and those without boost, respectively. Five-year OS, including salvage therapy, was excellent (boost vs. no boost: 97% vs. 95%, P = 0.58). CONCLUSIONS: Outcome data demonstrate that omission of the radiotherapy boost to the loco-regional positive lymph nodes in patients with intermediate-risk, stage III WT who receive preoperative chemotherapy and postoperative flank irradiation (14.4 Gy) can be considered a safe approach for future SIOP protocols.
OBJECTIVE: To evaluate the value of radiotherapy boost omission in patients with intermediate-risk, stage III Wilms tumours (WT) with positive lymph nodes (LN). METHODS AND MATERIALS: All patients with intermediate-risk, stage III (LN positive) WT consecutively registered in the SIOP-WT-2001 study were included in this analysis. Endpoints were 5-year event-free survival (EFS), loco-regional control (LRC) and overall survival (OS). RESULTS: Between June 2001 and May 2015, 2,569 patients with stage I to III WT after preoperative chemotherapy were registered in the SIOP-WT-2001 study. Five hundred and twenty-three (20%) had stage III disease, of which 113 patients had stage III due to positive LN only. Of those, 101 (89%) received radiotherapy, 36 of which (36%) received, apart from flank irradiation, a boost dose to the LN positive area. Four patients (4%) did not receive any adjuvant radiotherapy. In eight patients information on radiotherapy was not available. With a median follow-up of 71 months, no difference in 5-year EFS (84% vs. 83%, P = 0.77) and LRC (96% vs. 97%, P = 0.91) was observed between patients receiving a radiotherapy boost and those without boost, respectively. Five-year OS, including salvage therapy, was excellent (boost vs. no boost: 97% vs. 95%, P = 0.58). CONCLUSIONS: Outcome data demonstrate that omission of the radiotherapy boost to the loco-regional positive lymph nodes in patients with intermediate-risk, stage III WT who receive preoperative chemotherapy and postoperative flank irradiation (14.4 Gy) can be considered a safe approach for future SIOP protocols.
Authors: Peter F Ehrlich; Yueh-Yun Chi; Murali M Chintagumpala; Fredric A Hoffer; Elizabeth J Perlman; John A Kalapurakal; Brett Tornwall; Anne Warwick; Robert C Shamberger; Geetika Khanna; Thomas E Hamilton; Kenneth W Gow; Arnold C Paulino; Eric J Gratias; Elizabeth A Mullen; James I Geller; Paul E Grundy; Conrad V Fernandez; Jeffrey S Dome Journal: Cancer Date: 2020-05-27 Impact factor: 6.860
Authors: M E Madeleine van der Perk; Nicholas G Cost; Annelies M E Bos; Robert Brannigan; Tanzina Chowdhury; Andrew M Davidoff; Najat C Daw; Jeffrey S Dome; Peter Ehrlich; Norbert Graf; James Geller; John Kalapurakal; Kathleen Kieran; Marcus Malek; Mary F McAleer; Elizabeth Mullen; Luke Pater; Angela Polanco; Rodrigo Romao; Amanda F Saltzman; Amy L Walz; Andrew D Woods; Marry M van den Heuvel-Eibrink; Conrad V Fernandez Journal: Int J Cancer Date: 2022-05-11 Impact factor: 7.316