Takaharu Oue1, Koji Fukumoto2, Ryota Souzaki3, Tetsuya Takimoto4, Tsugumichi Koshinaga5. 1. Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 63-8501, Hyogo, Japan. ta-oue@hyo-med.ac.jp. 2. Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan. 3. Department of Pediatric Surgery, Kyushu University Graduate School on Medicine, Fukuoka, Japan. 4. Department of Childhood Cancer Data Management, National Center for Child Health and Development, Tokyo, Japan. 5. Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND/ OBJECTIVES: Treatment is more intensive for stage III Wilms tumor (WT) than for stages I and II non-metastatic WTs. Various factors including tumor spillage, unresectability, and lymph node metastasis are responsible for stage III disease. The present study aimed to not identify clinical factors associated with the features of stage III WT to establish new treatment strategies. DESIGN/ METHODS: Of 166 patients with non-metastatic WT enrolled in the Japan Wilms Tumor Study (JWiTS)-2, 51 patients had stage III disease. The treatment protocol for JWiTS-2 was essentially the same as that in the National Wilms Tumor study (NWTS)-5. Local hospitals were surveyed to collect details of clinical findings related to stage III disease, and data regarding 45 (88%) patients were obtained. RESULTS: Nine patients with massive tumors underwent preoperative chemotherapy. Biopsy was performed in 6. Reduction in the tumor size was achieved in 8 of the 9 cases. Nephrectomy was finally performed in all of them. Thirty-six patients underwent primary nephrectomy. The reason for the stage III disease was lymph node metastasis (n = 9, 25%), tumor spillage (n = 20, 56%), and tumor extension/incomplete resection (n = 17, 47%). Some patients had more than one of these factors. Most patients were treated with the DD-4A regimen, and 43 (95.6%) of the 45 patients received abdominal radiation therapy. Tumors recurred in three patients (local, 1; metastasis, 2), and two patients died. Overall and relapse-free survival rates were 95.2% and 90.8%, respectively. CONCLUSION: The prognosis of stage III WT was good. In the next stage, the doses of chemotherapy and radiotherapy should be reduced to avoid late effects. The high rate of tumor spillage after primary resection suggests that preoperative chemotherapy should be started instead of aggressive tumor resection in the large tumor cases with surgical risks.
BACKGROUND/ OBJECTIVES: Treatment is more intensive for stage III Wilms tumor (WT) than for stages I and II non-metastatic WTs. Various factors including tumor spillage, unresectability, and lymph node metastasis are responsible for stage III disease. The present study aimed to not identify clinical factors associated with the features of stage III WT to establish new treatment strategies. DESIGN/ METHODS: Of 166 patients with non-metastatic WT enrolled in the Japan Wilms Tumor Study (JWiTS)-2, 51 patients had stage III disease. The treatment protocol for JWiTS-2 was essentially the same as that in the National Wilms Tumor study (NWTS)-5. Local hospitals were surveyed to collect details of clinical findings related to stage III disease, and data regarding 45 (88%) patients were obtained. RESULTS: Nine patients with massive tumors underwent preoperative chemotherapy. Biopsy was performed in 6. Reduction in the tumor size was achieved in 8 of the 9 cases. Nephrectomy was finally performed in all of them. Thirty-six patients underwent primary nephrectomy. The reason for the stage III disease was lymph node metastasis (n = 9, 25%), tumor spillage (n = 20, 56%), and tumor extension/incomplete resection (n = 17, 47%). Some patients had more than one of these factors. Most patients were treated with the DD-4A regimen, and 43 (95.6%) of the 45 patients received abdominal radiation therapy. Tumors recurred in three patients (local, 1; metastasis, 2), and two patients died. Overall and relapse-free survival rates were 95.2% and 90.8%, respectively. CONCLUSION: The prognosis of stage III WT was good. In the next stage, the doses of chemotherapy and radiotherapy should be reduced to avoid late effects. The high rate of tumor spillage after primary resection suggests that preoperative chemotherapy should be started instead of aggressive tumor resection in the large tumor cases with surgical risks.
Authors: Daniel M Green; Yevgeny A Grigoriev; Bin Nan; Janice R Takashima; Pat A Norkool; Giulio J D'Angio; Norman E Breslow Journal: J Clin Oncol Date: 2003-06-15 Impact factor: 44.544
Authors: Paul Grundy; Elizabeth Perlman; Nancy S Rosen; Anne B Warwick; Julia Glade Bender; Peter Ehrlich; Frederic A Hoffer; Nadine Deannie Lee Journal: Curr Probl Cancer Date: 2005 Sep-Oct Impact factor: 3.187
Authors: D M Green; Y A Grigoriev; B Nan; J R Takashima; P A Norkool; G J D'Angio; N E Breslow Journal: J Clin Oncol Date: 2001-04-01 Impact factor: 44.544
Authors: R C Shamberger; K A Guthrie; M L Ritchey; G M Haase; J Takashima; J B Beckwith; G J D'Angio; D M Green; N E Breslow Journal: Ann Surg Date: 1999-02 Impact factor: 12.969
Authors: Norman E Breslow; San-San Ou; J Bruce Beckwith; Gerald M Haase; John A Kalapurakal; Michael L Ritchey; Robert C Shamberger; Patrick R M Thomas; Giulio J D'Angio; Daniel M Green Journal: Cancer Date: 2004-09-01 Impact factor: 6.860
Authors: Tom Monclair; Garrett M Brodeur; Peter F Ambros; Hervé J Brisse; Giovanni Cecchetto; Keith Holmes; Michio Kaneko; Wendy B London; Katherine K Matthay; Jed G Nuchtern; Dietrich von Schweinitz; Thorsten Simon; Susan L Cohn; Andrew D J Pearson Journal: J Clin Oncol Date: 2008-12-01 Impact factor: 44.544
Authors: Susan L Cohn; Andrew D J Pearson; Wendy B London; Tom Monclair; Peter F Ambros; Garrett M Brodeur; Andreas Faldum; Barbara Hero; Tomoko Iehara; David Machin; Veronique Mosseri; Thorsten Simon; Alberto Garaventa; Victoria Castel; Katherine K Matthay Journal: J Clin Oncol Date: 2008-12-01 Impact factor: 44.544
Authors: G J D'Angio; A E Evans; N Breslow; B Beckwith; H Bishop; P Feigl; W Goodwin; L L Leape; L F Sinks; W Sutow; M Tefft; J Wolff Journal: Cancer Date: 1976-08 Impact factor: 6.860