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

McAleer, Mary Frances; Melchior, Patrick; Parkes, Jeannette; Pater, Luke; Rübe, Christian; Saunders, Daniel; Paulino, Arnold C.; Janssens, Geert O.; Kalapurakal, John A.

doi:10.1002/pbc.30090

Cited by 2 publications

(1 citation statement)

References 52 publications

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“…However, SCPs have not been shown to improve patient reported outcomes due to notable barriers to routine implementation relating to health care providers and survivors such as lack of family and social support for survivors especially among minorities, lack of transition of care, lack of interest and knowledge among primary care providers, knowledge gap among survivors, lack of financial support and psychologic issues including addictions among survivors, among others [70][71][72][73]. All of these issues need to be addressed by the global medical community, and new health care models with improved collaboration, better coordination and more communication among survivors and their clinicians will be required to translate the benefits of many of these innovations in late effects research to individual childhood cancer survivors [68,74].…”

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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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confidence: 99%

Long-Term Toxicities among Wilms Tumor Survivors

Patel¹,

Lo²,

Pater³

et al. 2023

Radiation Therapy

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Survival and Toxicity Outcomes with Radiotherapy Technique and Timing in the Management of Wilms Tumor: a Systematic Review to Inform a National Clinical Practice Guideline Development

Bacorro,

Lardizabal-Bunyi,

Rodriguez

et al. 2024

JMUST

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Purpose: Wilms tumor (WT) management has evolved into a multimodality paradigm that includes radiotherapy (RT), usually as an adjuvant or consolidative modality. Protocols are refined to maximize cure and compliance while minimizing acute toxicity and long-term effects. RT technique and timing are two factors that could improve these outcomes. We reviewed the evidence on survival and toxicity outcomes among WT patients with conventional versus advanced RT techniques and early versus delayed RT to inform a Department of Health (DOH) commissioned guideline. Materials and Methods: We systematically searched PubMed, EuropePMC, EBSCOHost, HERDIN, systematic review and clinical trial registries and official websites of scientific societies for relevant publications and grey literature. Eligibility screening, risk-of-bias assessment and data extraction were performed using a single-reviewer approach. Given the study and data heterogeneity, only a qualitative synthesis was performed. Certainty of evidence assessment was done using the GRADE approach. Results: We screened 314 studies and included seven in the review, including a phase 1/2 trial and six retrospective studies, all from first-world countries (US, France, Netherlands), except one from a newly industrialized country (Brazil). The certainty of evidence on the survival and toxicity outcomes with advanced RT techniques was very low. Moderate-certainty evidence supports that giving RT >14 days after surgery leads to increased mortality. Conclusion: Current evidence does not support the routine use of advanced RT techniques; proper contextualization is necessary. Tertiary centers managing WT should strive to administer RT within 14 days after surgery whenever possible. Keywords: Wilms tumor, nephroblastoma, radiotherapy, intensity-modulated radiotherapy, survival, toxicity

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

Cited by 2 publications

References 52 publications

Long-Term Toxicities among Wilms Tumor Survivors

Long-Term Toxicities among Wilms Tumor Survivors

Survival and Toxicity Outcomes with Radiotherapy Technique and Timing in the Management of Wilms Tumor: a Systematic Review to Inform a National Clinical Practice Guideline Development

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