Evaluation of radiation dose to cardiac and pulmonary tissue among patients with stage IV Wilms tumor and pulmonary metastases

Farooqi, Ahsan; Siddiqi, A; Esiashvili, Natia

doi:10.1002/pbc.25007

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…37 To limit overall morbidity for WT survivors, a major initiative in the development of modern treatment protocols has been the reduction of anthracycline and/or radiation dose and omission of radiotherapy for certain populations. 14,[38][39][40][41][42][43] The findings from the current study support the need for continuous vigilance in these efforts and reinforce the importance of avoidance of tumor spillage during surgery or inadequate surgical staging that may result in disease upstaging. 6,39,44 Several limitations with the present study should be considered.…”

Section: Journal Of Clinical Oncologysupporting

confidence: 74%

Late Health Outcomes Among Survivors of Wilms Tumor Diagnosed Over Three Decades: A Report From the Childhood Cancer Survivor Study

Weil

Murphy

Liu

et al. 2023

JCO

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PURPOSE To evaluate long-term morbidity and mortality among unilateral, nonsyndromic Wilms tumor (WT) survivors according to conventional treatment regimens. METHODS Cumulative incidence of late mortality (≥ 5 years from diagnosis) and chronic health conditions (CHCs) were evaluated in WT survivors from the Childhood Cancer Survivor Study. Outcomes were evaluated by treatment, including nephrectomy combined with vincristine and actinomycin D (VA), VA + doxorubicin + abdominal radiotherapy (VAD + ART), VAD + ART + whole lung radiotherapy, or receipt of ≥ 4 chemotherapy agents. RESULTS Among 2,008 unilateral WT survivors, 142 deaths occurred (standardized mortality ratio, 2.9, 95% CI, 2.5 to 3.5; 35-year cumulative incidence of death, 7.8%, 95% CI, 6.3 to 9.2). The 35-year cumulative incidence of any grade 3-5 CHC was 34.1% (95% CI, 30.7 to 37.5; rate ratio [RR] compared with siblings 3.0, 95% CI, 2.6 to 3.5). Survivors treated with VA alone had comparable risk for all-cause late mortality relative to the general population (standardized mortality ratio, 1.0; 95% CI, 0.5 to 1.7) and modestly increased risk for grade 3-5 CHCs compared with siblings (RR, 1.5; 95% CI, 1.1 to 2.0), but remained at increased risk for intestinal obstruction (RR, 9.4; 95% CI, 3.9 to 22.2) and kidney failure (RR, 11.9; 95% CI, 4.2 to 33.6). Magnitudes of risk for grade 3-5 CHCs, including intestinal obstruction, kidney failure, premature ovarian insufficiency, and heart failure, increased by treatment group intensity. CONCLUSION With approximately 40% of patients with newly diagnosed WT currently treated with VA alone, the burden of late mortality/morbidity in future decades is projected to be lower than that for survivors from earlier eras. Nevertheless, the risk of late effects such as intestinal obstruction and kidney failure was elevated across all treatment groups, and there was a dose-dependent increase in risk for all grade 3-5 CHCs by treatment group intensity.

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Section: Journal Of Clinical Oncologysupporting

confidence: 74%

Late Health Outcomes Among Survivors of Wilms Tumor Diagnosed Over Three Decades: A Report From the Childhood Cancer Survivor Study

Weil

Murphy

Liu

et al. 2023

JCO

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“…Modern RT techniques such as cardiac sparing whole lung intensity-modulated radiation therapy (IMRT) techniques haves been shown statistically significant reduction of cardiac and myocardial RT doses compared to standard AP-PA WLI techniques in a prospective clinical trial [12]. Another report showed that the mean cardiac dose was significantly higher when the lung and abdomen RT fields were treated sequentially compared to when they were treated concurrently [18]. All current and future COG protocols will permit the use of cardiac sparing whole lung IMRT with central quality assurance review, concurrent treatment of lung and abdomen RT fields and IMRT/proton therapy for the treatment of flank and whole abdomen.…”

Section: Mitigation Strategies and Surveillance Guidelinesmentioning

confidence: 99%

Long-Term Toxicities among Wilms Tumor Survivors

Patel¹,

Lo²,

Pater³

et al. 2023

Radiation Therapy

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Successive trials conducted by the National Wilms Tumor Study have resulted in very high cure rates for children with Wilms tumor (WT). These trials have also significantly reduced the indications for doxorubicin and higher doses of RT in WT. Late toxicities after multimodality treatment especially RT, continues to be a major problem among WT survivors. Higher doses of RT is the most important factor responsible for the many late effects including congestive heart failure, secondary malignant neoplasms, hypogonadism, infertility and pregnancy complications, pulmonary disease, musculoskeletal effects, renal failure and diabetes mellitus. The potential for novel RT techniques like IMRT and proton therapy to reduce the incidence of these toxicities is discussed. The surveillance recommendations for WT survivors are mainly derived from the COG long-term follow-up guidelines. The future directions in late effects research include novel research to improve current knowledge of association between RT doses to target organs and late effects, discovery of novel biomarkers, and identification of predictive genetic biomarkers. Despite all these advances, there are significant challenges facing the global health care community that need to be overcome before the benefits of these innovations in late effects research can be translated to individual cancer survivors.

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“…Recent analysis of WT outcomes in the US National Cancer Database showed that surgery‐to‐radiation interval ≤14 days was associated with improved OS in nonmetastatic patients, but no relationship was found for metastatic patients 24 . In upcoming COG protocols, flank/abdomen RT will be delayed until week 6 for stage IV patients with lung metastases so that both sites can be treated simultaneously to avoid higher radiation doses to organs such as heart and lungs at overlapping field edges 25 …”

Section: Controversiesmentioning

confidence: 99%

“…24 In upcoming COG protocols, flank/abdomen RT will be delayed until week 6 for stage IV patients with lung metastases so that both sites can be treated simultaneously to avoid higher radiation doses to organs such as heart and lungs at overlapping field edges. 25…”

Section: Rt Timingmentioning

confidence: 99%

Harmonica consensus, controversies, and future directions in radiotherapy for pediatric Wilms tumors

McAleer

Melchior

Parkes

et al. 2022

Pediatric Blood & Cancer

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Radiotherapy (RT) is essential for multimodality treatment of pediatric renal tumors, particularly in higher-risk and metastatic disease. Despite decades of use, particularly for Wilms tumor, there remain controversies regarding RT indications, timing, dose, and targets. To align global management, we address these issues in this international HARMONIsation and CollAboration (HARMONICA) project. There are multiple knowledge gaps and opportunities for future research including: (1) utilization of advanced RT technologies, including intensity-modulated RT, proton beam therapy, combined with image-guided RT to reduce target volumes; (2) impact of molecular biomarkers including loss of heterozygosity at 1p, 16q, and 1q gain on RT indications;(3) mitigation of reproductive toxicity following RT; (4) promotion of RT late effects research; and (5) support to overcome challenges in RT utilization in low-and middleincome countries where 90% of the world's children reside. Here, we outline current status and future directions for RT in pediatric renal tumors.

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Evaluation of radiation dose to cardiac and pulmonary tissue among patients with stage IV Wilms tumor and pulmonary metastases

Cited by 6 publications

References 21 publications

Late Health Outcomes Among Survivors of Wilms Tumor Diagnosed Over Three Decades: A Report From the Childhood Cancer Survivor Study

Late Health Outcomes Among Survivors of Wilms Tumor Diagnosed Over Three Decades: A Report From the Childhood Cancer Survivor Study

Long-Term Toxicities among Wilms Tumor Survivors

Harmonica consensus, controversies, and future directions in radiotherapy for pediatric Wilms tumors

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