Preoperative versus postoperative radiotherapy, single versus multiple courses of actinomycin d, in the treatment of Wilms' tumor. Preliminary results of a controlled clinical trial conducted by the international society of paediatric oncology (S.I.O.P.)

Abstract

The preliminary results of a controlled clinical trial organized by the S.I.O.P. of radiotherapy and chemotherapy in patients with nephroblastoma are presented. Forty-two centers have participated. Between September 1971 and October 1974,398 patients were registered; 195 were eligible for the trial and were randomized. The remaining 203 patients were excluded from the trial, but were followed in the same way as the patients in the trial. The results were evaluated in terms of recurrence-free survival rate and survival rate. Results in patients who received preoperative and postoperative radiotherapy (group A, 73 patients) were compared with the results in patients who recieved only postoperative radiotherapy (group B, 64 patients). The tumor ruptured at surgery in three patients of group A, and in 20 patients of group B, a difference that is statistically significant. No significant difference in survival a n d recurrence-free survival between groups A and B is observed at present. Results in patients treated with a single course of actinomycin D (group I, 80 patients)were compared with the results in patients treated with multiple courses (group 11, 80 patients). At present, no significant difference is found between the two groups.

Single-doseversus fractionated-dose dactinomycin in the treatment of wilms' tumor. Preliminary results of a clinical trial

“…This fundamental difference in schedules could explain why relatively low rates of treatment-related toxicity were seen in our study, whereas hepatic toxicity seemed to be a significant problem in the NWTS-4. l 7 An important dividend of this first GCBTTW trial was the ability to extend the advantages of one of the best treatment protocols available for WT to several major cancer treatment centers in Brazil. We estimate that the trial accrued approximately 25% of all new cases of WT occurring in the entire country during that period (estimated to be 740 cases based on an age-specific rate of 7 per 1 million and a mid-period population at risk of 49 million children 0 to 14 years of age).…”

Management of the Debilitated Child with Massive Wilms' Tumor

“…According to the NWTSG, 2 surgery should be performed immediately following diagnosis to remove the tumor early to eliminate the possibility of dissemination. The Societe Internationale d'Oncologie Pediàtrique (SIOP), 3 on the other hand, advocates preoperative radiotherapy to reduce the bulk of the tumor, rendering its resection "safer and easier" and to "devitalize" the tumor cells that may invade the blood stream during surgery, thus reducing the frequency of metastases. The clinical trials that were initiated in 1970, however, failed to demonstrate an advantage in survival over the NWTSG approach.…”

“…The clinical trials that were initiated in 1970, however, failed to demonstrate an advantage in survival over the NWTSG approach. 2,3 Preoperative vincristine alone, 4,5 vincristine and actinomycin D, 6 vincristine plus radiotherapy, and actinomycin D alone 7 have been used in different trials with the objective of improving the operability of the primary tumor. Preoperative embolization of the tumor has been tried in a few cases.…”

Prognostic Impact of HER/2 Expression on Survival of Preoperatively Treated Children with Wilms Tumor at South Egypt

“…The SIOP in Europe exhibited that preoperative chemotherapy facilitated surgery and reduced the occurrence of tumor spillage at the time of surgery and this will result in a good survival outcome [6]. Meanwhile, it doesn't significantly obscure important histopathologic parameters [7] [8].…”