Second malignant neoplasms following treatment for Wilm's tumor: a report from the National Wilms' Tumor Study Group.

Breslow, Norman E.; Takashima, Janice R.; Whitton, John; Moksness, Jami; D’Angio, Giulio J.; Green, Daniel M.

doi:10.1200/jco.1995.13.8.1851

Cited by 215 publications

(126 citation statements)

References 32 publications

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“…Evidence of deleterious effects in promoting second cancers, cardiomyopathies (in patients also receiving DOX), developmental abnormalities and adverse pregnancy outcomes, by contrast, may take decades to develop. (18)(19)(20)(21) There is no guarantee that use of RT to prevent flank recurrence will improve long term survival. The present study was undertaken to determine if reduction in use of RT between NWTS-3 and NWTS-4 had adversely affected survival outcomes for patients with FH disease.…”

Section: Introductionmentioning

confidence: 99%

Radiation therapy for favorable histology Wilms tumor: Prevention of flank recurrence did not improve survival on National Wilms Tumor Studies 3 and 4

Breslow

Beckwith

Haase

et al. 2006

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To determine whether radiation therapy (RT) of patients with Wilms tumor of favorable histology (FH) prevented flank recurrence and thereby improved the survival outcome.Methods and Materials-Recurrence and mortality risks were compared among groups of patients with stage I-IV/FH Wilms tumor enrolled in the 3 rd (n=1640) and 4 th (n=2066) National Wilms Tumor Study Group (NWTSG) studies.Results-Proportions of patients with flank recurrence were 0/513=0.0% for 20 Gy, 12/805=1.5% for 10 Gy and 44/2388=1.8% for no flank RT (p-trend=0.001 adjusted for stage and doxorubicin); for intra-abdominal (including flank) recurrence they were 5/513=1.0%, 30/805= 3.7% and 58/2388=2.4%, respectively (p-trend=0.02 adjusted). Survival percentages at 8 years following intraabdominal recurrence were 0/5=0% for 20 Gy, 10/30=33% for 10 Gy and 34/58=56%) for no RT (p-trend=0.0001). NWTS-4 discontinued use of 20Gy RT and the 8 year flank recurrence risk Conclusions-Due partly to lower post-recurrence mortality among non-irradiated patients, prevention of flank recurrence by RT did not improve survival. It is important to evaluate entire treatment policies with regard to long-term outcomes.

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Section: Introductionmentioning

confidence: 99%

Radiation therapy for favorable histology Wilms tumor: Prevention of flank recurrence did not improve survival on National Wilms Tumor Studies 3 and 4

Breslow

Beckwith

Haase

et al. 2006

International Journal of Radiation Oncology*Biology*Physics

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“…30 A recent study that combined three cohorts of children with Wilms tumor for a total of 13,351 subjects followed for a median time of 11.6 years, observed the occurrence of 174 solid tumors, among which the most frequent were tumors of digestive organs, bones, breast, thyroid and 28 leukemias. 11 This study partially overlaps with ours, because one of the three cohorts consisted of 1,574 cases recorded in the cancer registries of Norway, Denmark, Iceland, Sweden and Finland from 1960 up to 2004.…”

Section: Epidemiologymentioning

confidence: 99%

Second malignancies after childhood noncentral nervous system solid cancer: Results from 13 cancer registries

Maule

Scélo

Pastore

et al. 2011

Intl Journal of Cancer

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Children diagnosed with noncentral nervous system solid cancers (NCNSSC) experience several adverse late effects, including second malignant neoplasm. The aim of our study was to assess the risk of specific second malignancies after a childhood NCNSSC. Diagnosis and follow-up data on 10,988 cases of NCNSSC in children (0-14 years) were obtained from 13 registries. Standardized incidence ratios (SIRs) with 95% confidence intervals (CI) and cumulative incidence of second malignancies were computed. We observed 175 second malignant neoplasms, yielding a SIR of 4.6, 95% CI: 3.9-5.3. When considering second

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“…In Wilms' tumor patients in general, a cumulative risk of a SMN was 1.6% at 15 years after diagnosis in the NWTS series. 12 Abdominal irradiation increased the risk of SMNs in a dose-dependent manner. 12 In a recent report from SIOP, the cumulative incidence of second cancers was 0.65% at 15 years, the risk being fivefold compared to the general population.…”

Section: Discussionmentioning

confidence: 99%

“…The observed increased risk of SMNs in bilateral Wilms' tumor patients 10,11 has, however, not been confirmed by NWTS. 12 That tumor formation depends on two rate-limiting genetic events has been proposed in Knudson and Strong's model for Wilms' tumor. 13 Radiotherapy offers the second genetic event required for tumorigenesis in these patients, analogously to patients with retinoblastoma, 14 and should therefore preferably be avoided.…”

mentioning

confidence: 99%

Maximal preservation of renal function in patients with bilateral Wilms’ tumor: therapeutic strategy of late kidney-sparing surgery and replacement of radiotherapy by high-dose melphalan and stem cell rescue

Saarinen-Pihkala

Wikström

Vettenranta

1998

Bone Marrow Transplant

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Summary:In children with bilateral Wilms' tumor, the therapy should aim at maximal preservation of renal parenchyma and function. Local radiotherapy may give rise to second malignant neoplasms and may impair renal function. We present a therapeutic strategy without any irradiation. Three children were diagnosed with bilateral Wilms' tumor at ages from 6 months to 5 years. Each patient had a massive tumor with local stage III on one side; one had pulmonary metastases. The therapeutic strategy was first to obtain tissue for histology by percutaneous needle biopsy, to administer pre-operative chemotherapy until desired tumor shrinkage, and then to perform kidney-sparing resective surgery. After a period of conventional chemotherapy, the patients were consolidated with high-dose (HD) melphalan and ABMT. Renal parenchyma spared post-surgery (right/left) was 0%/70%, 60%/40% and 40%/60% of the original kidney volumes. The toxicity of the ABMT procedure was mild, the patients engrafted promptly, and were discharged on days +14 to +27. All patients survive disease-free, 3 years 4 months to 4 years 5 months post-transplant. Our program resulted in good preservation of renal parenchyma and normal function, and we consider the risk of this ABMT program smaller than the late consequences of local radiotherapy for children with bilateral Wilms' tumor. The therapeutic strategy described merits further evaluation. Keywords: autologous bone marrow transplantation; melphalan, high-dose; pre-operative chemotherapy; renal function; renal growth; Wilms' tumor, bilateral Wilms' tumor is one of the pediatric malignancies with the best success of cure today.1,2 In the National Wilms' Tumor Study (NWTS) 3, the 3-year relapse rates were 10, 12, 22 and 22% for stages I-IV in patients with favorable histology (FH).1 The corresponding relapse rates in unfavorable histology (UH) patients for stage I-III and IV were 36% and 45%, respectively. The overall relapse rate in Correspondence: Dr UM Saarinen-Pihkala, Hospital for Children and Adolescents,

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Second malignant neoplasms following treatment for Wilm's tumor: a report from the National Wilms' Tumor Study Group.

Cited by 215 publications

References 32 publications

Radiation therapy for favorable histology Wilms tumor: Prevention of flank recurrence did not improve survival on National Wilms Tumor Studies 3 and 4

Radiation therapy for favorable histology Wilms tumor: Prevention of flank recurrence did not improve survival on National Wilms Tumor Studies 3 and 4

Second malignancies after childhood noncentral nervous system solid cancer: Results from 13 cancer registries

Maximal preservation of renal function in patients with bilateral Wilms’ tumor: therapeutic strategy of late kidney-sparing surgery and replacement of radiotherapy by high-dose melphalan and stem cell rescue

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