1
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Benedetti DJ, Varela CR, Renfro LA, Tornwall B, Dix DB, Ehrlich PF, Glick RD, Kalapurakal J, Perlman E, Gratias E, Seibel NL, Geller JI, Khanna G, Malogolowkin M, Grundy P, Fernandez CV, Dome JS, Mullen EA. Treatment of children with favorable histology Wilms tumor with extrapulmonary metastases: A report from the COG studies AREN0533 and AREN03B2 and NWTSG study NWTS-5. Cancer 2024; 130:947-961. [PMID: 37933882 PMCID: PMC10922062 DOI: 10.1002/cncr.35099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/02/2023] [Accepted: 09/21/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Patients with stage IV favorable histology Wilms tumor (FHWT) with extrapulmonary metastases (EPM) constitute a small subset of patients with FHWT. Because of their rarity and heterogeneity, optimal FHWT treatment is not well understood. Children's Oncology Group protocol AREN0533 assigned patients with FHWT and EPM to intensified chemotherapy, regimen M, after initial DD-4A chemotherapy. To improve understanding of prognostic factors and best therapies, experiences of patients with EPM on AREN0533, as well as on protocols AREN03B2 and NWTS-5, were reviewed. METHODS Combined outcomes for patients with EPM from NWTS-5, AREN0533, and AREN03B2 were determined. Those treated on AREN0533 were compared with those treated on NWTS-5. Prognostic factors were explored in the pooled cohort. RESULTS Forty-seven patients with FHWT with EPM enrolled on AREN0533, 37 enrolled on NWTS-5, and 64 were followed only on AREN03B2. The pooled cohort of all 148 patients demonstrated a 4-year event-free survival (EFS) of 77.3% (95% CI, 70.8-84.4) and 4-year overall survival of 88.9% (95% CI, 83.9-94.2). Four-year EFS of patients with EPM treated on AREN0533 was 76.0% (95% CI, 64.6-89.4) vs 64.9% (95% CI, 51.7-82.2) on NWTS-5; hazard ratio, 0.64, p = .26; no difference in overall survival was observed. Increasing linear age and slow incomplete lung response were associated with worse EFS in a pooled cohort. CONCLUSIONS Outcomes for patients with EPM are among the lowest for children with FHWT. Further trials with standardized surgical and radiation treatment to metastatic sites, and prospectively collected biologic and treatment details are needed. CLINICAL TRIAL REGISTRATION Clinical Trials.gov identifiers: NCT00379340, NCT00898365, and NCT00002611.
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Affiliation(s)
- Daniel J Benedetti
- Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carly R Varela
- Division of Hematology and Oncology, Pediatric Specialists of Virginia, Inova Fairfax Hospital, Fairfax, Virginia, USA
- Janssen Research and Development, Spring House, Pennsylvania, USA
- Division of Oncology, Children's National Hospital and the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Lindsay A Renfro
- Division of Biostatistics, University of Southern California, Los Angeles, California, USA
- Children's Oncology Group, Los Angeles, California, USA
| | | | - David B Dix
- Division of Oncology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Peter F Ehrlich
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard D Glick
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - John Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth Perlman
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Eric Gratias
- eviCore Healthcare, Bluffton, South Carolina, USA
| | - Nita L Seibel
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Geetika Khanna
- Department of Radiology & Imaging Sciences, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Marcio Malogolowkin
- Division of Pediatric Hematology-Oncology, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Paul Grundy
- Division of Immunology, Hematology, Oncology, Palliative Care and Environmental Interactions, University of Alberta, Edmonton, Alberta, Canada
| | - Conrad V Fernandez
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey S Dome
- Division of Oncology, Children's National Hospital and the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Elizabeth A Mullen
- Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts, USA
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Fleming AM, Mansfield SA, Jancelewicz T, Gosain A, Eubanks JW, Davidoff AM, Langham MR, Murphy AJ. Hepatic Metastasectomy in Pediatric Patients: An Observational Study. J Pediatr Surg 2024; 59:247-253. [PMID: 37980196 DOI: 10.1016/j.jpedsurg.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND The role of hepatectomy for metastatic disease in children is controversial. Rationales include potential cure, obtaining a diagnosis, and guiding chemotherapy decisions. This study examines the safety and utility of hepatic metastasectomy for children at a single institution. METHODS After IRB approval (#22-1258), medical records were reviewed from 1995 to 2022 for children undergoing hepatic metastasectomy. En-bloc hepatectomies during primary tumor resection were excluded. RESULTS Hepatic metastasectomy was performed in 16 patients for a variety of histologies. Median patient age was 12.2 years [IQR 6.9-22.6], and 13/16 patients were female (81 %). Number of hepatic metastases ranged from 1 to 23 and involved between 1 and 8 Couinaud segments. Anatomic resections included 4 hemihepatectomies and 1 sectionectomy. All other resections were nonanatomic. 3/6 resections for germ cell tumor (GCT) revealed only mature teratoma, driving adjuvant therapy decisions. When indicated, median time to adjuvant chemotherapy was 19 days [IQR 11-22]. No patients had Clavien-Dindo Class III or higher perioperative morbidity. Three patients (1 GCT, 1 adrenocortical carcinoma (ACC), and 1 gastric neuroendocrine tumor (GNET) experienced hepatic relapse. The patients with relapsed GCT and GNET are alive with disease at 17 and 135 months, respectively. The patient with ACC died of disease progression and liver failure. One patient with Wilms tumor experienced extrahepatic, retroperitoneal recurrence and died. With a median follow-up of 38 months, 10-year disease-specific and disease-free survival were 77 % and 61 %, respectively. CONCLUSIONS Hepatic metastasectomy can be accomplished safely in children, may guide adjuvant therapy decisions, and is associated with long-term survival in selected patients. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Treatment Study, Case series with no comparison group.
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Affiliation(s)
- Andrew M Fleming
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Sara A Mansfield
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Tim Jancelewicz
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Ankush Gosain
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - James W Eubanks
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Andrew M Davidoff
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Max R Langham
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Andrew J Murphy
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA.
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3
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Aldrink JH, Romao R, Ehrlich PF, Tracy E, Kieran K, Davidoff A, Glick R, Malek M, Huntington J, Saltzman AF, Cost NG, Shamberger RC. Critical elements of radical nephroureterectomy for pediatric unilateral renal tumor. Semin Pediatr Surg 2023; 32:151339. [PMID: 38006836 DOI: 10.1016/j.sempedsurg.2023.151339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Children with renal masses require surgical management to provide accurate surgical staging and skilled resection of the tumor. This document includes evidence-based recommendations for pediatric surgeons regarding the resection, staging, and proper nodal basin evaluation.
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Affiliation(s)
- Jennifer H Aldrink
- Nationwide Children's Hospital OSU College of Medicine, Columbus, OH 43205, USA.
| | | | - Peter F Ehrlich
- CS Mott Children's Hospital and the University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Kathleen Kieran
- Seattle Children's Hospital and the University of Washington, Seattle, WA 98105, USA
| | - Andrew Davidoff
- St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Richard Glick
- Cohen Children's Medical Center, New Hyde Park, NY 11042, USA
| | - Marcus Malek
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
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4
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Libes J, Hol J, Neto JCDA, Vallance KL, Tinteren HV, Benedetti DJ, Villar GLR, Duncan C, Ehrlich PF. Pediatric renal tumor epidemiology: Global perspectives, progress, and challenges. Pediatr Blood Cancer 2023; 70 Suppl 2:e30343. [PMID: 37096796 DOI: 10.1002/pbc.30343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 04/26/2023]
Abstract
Pediatric renal tumors account for 3%-11% of childhood cancers, the most common of which is Wilms tumor or nephroblastoma. Epidemiology plays a key role in cancer prevention and control by describing the distribution of cancer and discovering risk factors for cancer. Large pediatric research consortium trials have led to a clearer understanding of pediatric renal tumors, identification of risk factors, and development of more risk-adapted therapies. These therapies have improved event-free and overall survival for children. However, several challenges remain and not all children have benefited from the improved outcomes. In this article, we review the global epidemiology of pediatric renal tumors, including key consortium and global studies. We identify current knowledge gaps and challenges facing both high and low middle-incomes countries.
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Affiliation(s)
- Jaime Libes
- Department of Pediatrics, University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Janna Hol
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Kelly L Vallance
- Hematology and Oncology, Cook Children's Medical Center, Fort Worth, Texas, USA
| | | | - Daniel J Benedetti
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gema Lucia Ramirez Villar
- Hospital Universitario Virgen del Rocio, Pediatric Oncology Unit, University of Seville, Seville, Spain
| | - Catriona Duncan
- Great Ormond Street Hospital for Children (GOSH), NHS Foundation Trust, NIHR, Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Peter F Ehrlich
- Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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5
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Libes J, Hol J, Neto JCDA, Vallance KL, Tinteren HV, Benedetti DJ, Villar GLR, Duncan C, Ehrlich PF. Pediatric renal tumor epidemiology: Global perspectives, progress, and challenges. Pediatr Blood Cancer 2023; 70:e30006. [PMID: 36326750 DOI: 10.1002/pbc.30006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Pediatric renal tumors account for 3%-11% of childhood cancers, the most common of which is Wilms tumor or nephroblastoma. Epidemiology plays a key role in cancer prevention and control by describing the distribution of cancer and discovering risk factors for cancer. Large pediatric research consortium trials have led to a clearer understanding of pediatric renal tumors, identification of risk factors, and development of more risk-adapted therapies. These therapies have improved event-free and overall survival for children. However, several challenges remain and not all children have benefited from the improved outcomes. In this article, we review the global epidemiology of pediatric renal tumors, including key consortium and global studies. We identify current knowledge gaps and challenges facing both high and low middle-incomes countries.
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Affiliation(s)
- Jaime Libes
- Department of Pediatrics, University of Illinois College of Medicine, Peoria, Illinois, USA
| | - Janna Hol
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Kelly L Vallance
- Hematology and Oncology, Cook Children's Medical Center, Fort Worth, Texas, USA
| | | | - Daniel J Benedetti
- Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gema Lucia Ramirez Villar
- Hospital Universitario Virgen del Rocio, Pediatric Oncology Unit, University of Seville, Seville, Spain
| | - Catriona Duncan
- Great Ormond Street Hospital for Children (GOSH), NHS Foundation Trust, NIHR, Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Peter F Ehrlich
- Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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6
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McAleer MF, Melchior P, Parkes J, Pater L, Rübe C, Saunders D, Paulino AC, Janssens GO, Kalapurakal J. Harmonica consensus, controversies, and future directions in radiotherapy for pediatric Wilms tumors. Pediatr Blood Cancer 2022; 70 Suppl 2:e30090. [PMID: 36482883 DOI: 10.1002/pbc.30090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 12/13/2022]
Abstract
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 middle-income 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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Affiliation(s)
- Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick Melchior
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.,Low- and Middle-Income Countries Committee Co-Chair, Paediatric Radiation Oncology Society, Cape Town, South Africa
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | | | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - John Kalapurakal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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7
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MicroRNA-27a-5p Inhibits Proliferation, Migration, and Invasion and Promotes Apoptosis of Wilms' Tumor Cell by Targeting PBOV1. Mol Cell Biol 2022; 42:e0039721. [PMID: 35862727 PMCID: PMC9387294 DOI: 10.1128/mcb.00397-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Wilms' tumor is the most common type of renal tumor in children. MicroRNAs (miRNAs) are small noncoding RNAs that play crucial regulatory roles in tumorigenesis. We aimed to study the expression profile and function of miR-27a-5p in Wilms' tumor. miR-27a-5p expression was downregulated in human Wilms' tumor tissues. Functionally, overexpression of miR-27a-5p promoted cell apoptosis of Wilms' tumor cells. Furthermore, upregulated miR-27a-5p delayed xenograft Wilms' tumor tumorigenesis in vivo. Bioinformatics analysis predicted that miR-27a-5p directly targeted the 3'-untranslated region (3'-UTR) of PBOV1, and luciferase reporter assay confirmed the interaction between miR-27a-5p and PBOV1. The function of PBOV1 in Wilms' tumor was evaluated in vitro, and knockdown of PBOV1 dampened cell migration. In addition, overexpression of PBOV1 antagonized the tumor-suppressive effect of miR-27a-5p in Wilms' tumor cells. Collectively, our findings reveal the regulatory axis of miR-27a-5p/PBOV1 in Wilms' tumor, and miR-27a-5p might serve as a novel therapeutic target in Wilms' tumor.
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8
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Al-Hadidi A, Rinehardt HN, Sutthatarn P, Talbot LJ, Murphy AJ, Whitlock R, Condon S, Naik-Mathuria B, Utria AF, Rothstein DH, Chen SY, Wong-Michalak S, Kim ES, Short SS, Meyers RL, Kastenberg ZJ, Johnston ME, Zens T, Dasgupta R, Malek MM, Calabro K, Piché N, Callas H, Lautz TB, McKay K, Lovvorn HN, Commander SJ, Tracy ET, Lund SB, Polites SF, Davidson J, Dhooma J, Seemann NM, Marquart JP, Gainer H, Lal DR, Rich BS, Glick RD, Maloney L, Radu S, Fialkowski EA, Kwok PE, Romao RL, Rubalcava N, Ehrlich PF, Newman E, Diehl T, Le HD, Polcz V, Petroze RT, Stanek J, Aldrink JH. Incidence and Management of Pleural Effusions in Patients with Wilms Tumor: A Pediatric Surgical Oncology Research Collaborative Study. Int J Cancer 2022; 151:1696-1702. [PMID: 35748343 DOI: 10.1002/ijc.34188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/11/2022] [Accepted: 03/24/2022] [Indexed: 11/10/2022]
Abstract
Wilms tumor (WT) is the most common renal malignancy in children. Children with favorable histology WT achieve survival rates of over 90%. Twelve percent of patients present with metastatic disease, most commonly to the lungs. The presence of a pleural effusion at the time of diagnosis of WT may be noted on staging imaging; however, minimal data exist regarding the significance and prognostic importance of this finding. The objectives of this study are to identify the incidence of pleural effusions in patients with WT, and to determine the potential impact on oncologic outcomes. A multi-institutional retrospective review was performed from January 2009 to December 2019, including children with WT and a pleural effusion on diagnostic imaging treated at Pediatric Surgical Oncology Research Collaborative (PSORC) participating institutions. Of 1,259 children with a new WT diagnosis, 94 (7.5%) had a pleural effusion. Patients with a pleural effusion were older than those without (median 4.3 vs 3.5 years; p=0.004), and advanced stages were more common (local stage III 85.9% vs 51.9%; p<0.0001). Only 14 patients underwent a thoracentesis for fluid evaluation; 3 had cytopathologic evidence of malignant cells. Event-free and overall survival of all children with WT and pleural effusions was 86.2% and 91.5%, respectively. The rate and significance of malignant cells present in pleural fluid is unknown due to low incidence of cytopathologic analysis in our cohort; therefore, the presence of an effusion does not appear to necessitate a change in therapy. Excellent survival can be expected with current stage-specific treatment regimens.
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Affiliation(s)
- Ameer Al-Hadidi
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Hannah N Rinehardt
- Division of Pediatric General and Thoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Lindsay J Talbot
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Richard Whitlock
- Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Sienna Condon
- Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Alan F Utria
- Seattle Children's Hospital, University of Washington, Seattle, WA
| | | | - Stephanie Y Chen
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California
| | - Shannon Wong-Michalak
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California
| | - Eugene S Kim
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California
| | - Scott S Short
- Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | - Rebecka L Meyers
- Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | | | - Michael E Johnston
- Division of Pediatric General and Thoracic Surgery Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH
| | - Tiffany Zens
- Division of Pediatric General and Thoracic Surgery Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery Cincinnati Children's Hospital Medical Center, University of Cincinnati, OH
| | - Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kristen Calabro
- Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Qc, Canada
| | - Nelson Piché
- Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Qc, Canada
| | - Hannah Callas
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | - Timothy B Lautz
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | - Katlyn McKay
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah Jane Commander
- Department of Surgery, Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Elisabeth T Tracy
- Department of Surgery, Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Sarah B Lund
- Department of Surgery, Mayo Clinic, Rochester, MN
| | | | - Jacob Davidson
- Department of Surgery, Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Janel Dhooma
- Department of Surgery, Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Natashia M Seemann
- Department of Surgery, Division of Paediatric Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - John P Marquart
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Haley Gainer
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Dave R Lal
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Lauren Maloney
- Department of Surgery, Division of Pediatric Surgery, Oregon Health and Science University, Portland, OR
| | - Stephani Radu
- Department of Surgery, Division of Pediatric Surgery, Oregon Health and Science University, Portland, OR
| | - Elizabeth A Fialkowski
- Department of Surgery, Division of Pediatric Surgery, Oregon Health and Science University, Portland, OR
| | - Pei En Kwok
- Departments of Surgery and Urology, IWK Health, Dalhousie University, Halifax, NS, Canada
| | - Rodrigo Lp Romao
- Departments of Surgery and Urology, IWK Health, Dalhousie University, Halifax, NS, Canada
| | - Nathan Rubalcava
- University of Michigan Section of Pediatric Surgery, Ann Arbor, MI
| | - Peter F Ehrlich
- University of Michigan Section of Pediatric Surgery, Ann Arbor, MI
| | - Erika Newman
- University of Michigan Section of Pediatric Surgery, Ann Arbor, MI
| | - Thomas Diehl
- American Family Children's Hospital, University of Wisconsin-Madison, Madison, WI
| | - Hau D Le
- American Family Children's Hospital, University of Wisconsin-Madison, Madison, WI
| | - Valerie Polcz
- Division of Pediatric Surgery, University of Florida, Gainesville, FL
| | - Robin T Petroze
- Division of Pediatric Surgery, University of Florida, Gainesville, FL
| | - Joseph Stanek
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH
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9
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Green DM. Letter to the Editor: Impact of the First Generation of Children's Oncology Group Clinical Trials on Clinical Practice for Wilms Tumor. J Natl Compr Canc Netw 2022; 20:xlvi-xlvii. [PMID: 35276668 DOI: 10.6004/jnccn.2021.7109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Fuchs J, Murtha-Lemekhova A, Kessler M, Günther P, Hoffmann K. The role of liver resection in metastatic nephroblastoma: a systematic review and Meta-regression analysis. BMC Cancer 2022; 22:76. [PMID: 35038991 PMCID: PMC8764777 DOI: 10.1186/s12885-022-09182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of hepatic resection for liver metastases (LM) on the survival of pediatric patients with Wilms' tumor (WT) is unclear. So far, there is a lack of studies investigating the best suited treatment for patients with WTLM, and the role of liver resection has rarely been investigated. Thus, the development of evidence-based guidelines concerning indications of liver resection for WTLM remains difficult. AIM To investigate the role of surgery in the therapy of WTLM. All available data on liver resections and subgroup outcomes of patients with WTLM are analyzed. Main research question is whether liver resection improves survival rates of patients with WTLM compared to non-surgical treatment. METHODS A systematic literature search of MEDLINE, Web of Science, and Central provided the basis for this PRISMA-compliant systematic review. For the main analysis (I), all studies reporting on surgical treatment of pediatric WTLM were included. To provide a representative overview of the general outcome of WTLM patients, in analysis II all studies with cohorts of at least five WTLM patients, regardless of the kind of treatment, were reviewed and analyzed. A Multiple meta-regression model was applied to investigate the impact liver resection on overall survival. RESULTS 14 studies with reports of liver resection for WTLM were found (Analysis I). They included a total of 212 patients with WTLM, of which 93 underwent a liver resection. Most studies had a high risk of bias, and the quality was heterogenous. For the analysis II, eight studies with subgroups of at least five WTLM patients were found. The weighted mean overall survival (OS) of WTLM patients across the studies was 55% (SD 29). A higher rate of liver resection was a significant predictor of better OS in a multiple meta-regression model with 4 covariates (I2 29.43, coefficient 0.819, p = 0.038). CONCLUSIONS This is the first systematic review on WTLM. Given a lack of suited studies that specifically investigated WTLM, ecological bias was high in our analyses. Generating evidence is complicated in rare pediatric conditions and this study must be viewed in this context. Meta-regression analyses suggest that liver resection may improve survival of patients with WTLM compared to non-surgical treatment. Especially patients with persisting disease after neoadjuvant chemotherapy but also patients with metachronous LM seem to benefit from resection. Complete resection of LM is vital to achieve higher OS. Studies that prospectively investigate the impact of surgery on survival compared to non-surgical treatment for WTLM are highly needed to further close the current evidence gap. STUDY REGISTRATION PROSPERO 2021 CRD42021249763 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=249763 .
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Affiliation(s)
- Juri Fuchs
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Anastasia Murtha-Lemekhova
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Kessler
- Department of General, Visceral and Transplantation Surgery, Division of Pediatric Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Günther
- Department of General, Visceral and Transplantation Surgery, Division of Pediatric Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
- Division of Liver surgery, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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11
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Theilen TM, Braun Y, Bochennek K, Rolle U, Fiegel HC, Friedmacher F. Multidisciplinary Treatment Strategies for Wilms Tumor: Recent Advances, Technical Innovations and Future Directions. Front Pediatr 2022; 10:852185. [PMID: 35911825 PMCID: PMC9333359 DOI: 10.3389/fped.2022.852185] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Significant progress has been made in the management of Wilms tumor (WT) in recent years, mostly as a result of collaborative efforts and the implementation of protocol-driven, multimodal therapy. This article offers a comprehensive overview of current multidisciplinary treatment strategies for WT, whilst also addressing recent technical innovations including nephron-sparing surgery (NSS) and minimally invasive approaches. In addition, surgical concepts for the treatment of metastatic disease, advances in tumor imaging technology and potentially prognostic biomarkers will be discussed. Current evidence suggests that, in experienced hands and selected cases, laparoscopic radical nephrectomy and laparoscopic-assisted partial nephrectomy for WT may offer the same outcome as the traditional open approach. While NSS is the standard procedure for bilateral WT, NSS has evolved as an alternative technique in patients with smaller unilateral WT and in cases with imminent renal failure. Metastatic disease of the lung or liver that is associated with WT is preferably treated with a three-drug chemotherapy and local radiation therapy. However, surgical sampling of lung nodules may be advisable in persistent nodules before whole lung irradiation is commenced. Several tumor markers such as loss of heterozygosity of chromosomes 1p/16q, 11p15 and gain of function at 1q are associated with an increased risk of recurrence or a decreased risk of overall survival in patients with WT. In summary, complete resection with tumor-free margins remains the primary surgical aim in WT, while NSS and minimally invasive approaches are only suitable in a subset of patients with smaller WT and low-risk disease. In the future, advances in tumor imaging technology may assist the surgeon in defining surgical resection margins and additional biomarkers may emerge as targets for development of new diagnostic tests and potential therapies.
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Affiliation(s)
- Till-Martin Theilen
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Yannick Braun
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Konrad Bochennek
- Division of Pediatric Hematology and Pediatric Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Henning C Fiegel
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Florian Friedmacher
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
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12
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Nakata K, Williams R, Kinoshita Y, Koshinaga T, Moroz V, Al-Saadi R, Vujanic G, Oue T, Pritchard-Jones K. Comparative analysis of the clinical characteristics and outcomes of patients with Wilms tumor in the United Kingdom and Japan. Pediatr Blood Cancer 2021; 68:e29143. [PMID: 34056846 DOI: 10.1002/pbc.29143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Wilms tumor (WT) demonstrates epidemiological differences by world region and ethnicity. To enhance understanding of these differences, we retrospectively analyzed clinical trial data sets from the UK and Japan over a 20-year period. PROCEDURE We used data from three consecutive clinical trials in the UK and a single study in Japan that enrolled patients diagnosed during 1996-2015, to compare clinical characteristics and outcomes between countries. RESULTS During 1996-2015, 1395 patients in the UK and 537 in Japan were included. Japanese patients have a significantly younger median age at diagnosis than those in the UK (28 months vs 39 months). The proportion of patients with stage IV, large tumors, and anaplastic histology appears to be higher in the UK than in Japan (18% vs 11%, 62% vs 49%, 8% vs 3%, respectively). During 2005-2015, 77 hospitals treated WT in Japan compared with only 20 hospitals in the UK. Five-year overall survival of patients with WT was over 90% in both countries, but five-year event-free survival of patients with stage IV was significantly lower in Japan than in the UK (50.0% vs 76.2%, P = 0.001). CONCLUSIONS Differences in age of onset, tumor size at diagnosis, and histology may reflect differences in the genetic background of patients with WT between countries, but population-based phenotype-genotype data are lacking. The difference in survival probability for stage IV patients may be due to different diagnostic criteria or different treatment strategies. Prospective, international clinical studies including genomic analyses are needed to confirm these findings and improve clinical practice.
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Affiliation(s)
- Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Richard Williams
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Imperial BRC Genomics Facility, Imperial College London, London, UK
| | - Yoshiaki Kinoshita
- Malignant Tumor Committee, Japanese Society of Pediatric Surgeons, Tokyo, Japan
| | | | - Veronica Moroz
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Reem Al-Saadi
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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13
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Balis F, Green DM, Anderson C, Cook S, Dhillon J, Gow K, Hiniker S, Jasty-Rao R, Lin C, Lovvorn H, MacEwan I, Martinez-Agosto J, Mullen E, Murphy ES, Ranalli M, Rhee D, Rokitka D, Tracy EL, Vern-Gross T, Walsh MF, Walz A, Wickiser J, Zapala M, Berardi RA, Hughes M. Wilms Tumor (Nephroblastoma), Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:945-977. [PMID: 34416707 DOI: 10.6004/jnccn.2021.0037] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Wilms Tumor focus on the screening, diagnosis, staging, treatment, and management of Wilms tumor (WT, also known as nephroblastoma). WT is the most common primary renal tumor in children. Five-year survival is more than 90% for children with all stages of favorable histology WT who receive appropriate treatment. All patients with WT should be managed by a multidisciplinary team with experience in managing renal tumors; consulting a pediatric oncologist is strongly encouraged. Treatment of WT includes surgery, neoadjuvant or adjuvant chemotherapy, and radiation therapy (RT) if needed. Careful use of available therapies is necessary to maximize cure and minimize long-term toxicities. This article discusses the NCCN Guidelines recommendations for favorable histology WT.
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Affiliation(s)
- Frank Balis
- Abramson Cancer Center at the University of Pennsylvania
| | - Daniel M Green
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Shelly Cook
- University of Wisconsin Carbone Cancer Center
| | | | - Kenneth Gow
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Chi Lin
- Fred & Pamela Buffett Cancer Center
| | | | | | | | | | - Erin S Murphy
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Mark Ranalli
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Rhee
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Amy Walz
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Matthew Zapala
- UCSF Helen Diller Family Comprehensive Cancer Center; and
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14
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Groenendijk A, Spreafico F, de Krijger RR, Drost J, Brok J, Perotti D, van Tinteren H, Venkatramani R, Godziński J, Rübe C, Geller JI, Graf N, van den Heuvel-Eibrink MM, Mavinkurve-Groothuis AMC. Prognostic Factors for Wilms Tumor Recurrence: A Review of the Literature. Cancers (Basel) 2021; 13:cancers13133142. [PMID: 34201787 PMCID: PMC8268923 DOI: 10.3390/cancers13133142] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/18/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary A Wilms tumor is a childhood kidney tumor. In high-income countries, 90% of patients with this tumor survive. However, the tumor recurs in 15% of patients. It is important to identify the patients at risk of recurrence in order to adjust treatment in such a way that recurrence may potentially be prevented. However, we are currently unable to determine precisely which patients are at risk of recurrence. Therefore, we present an overview of factors that influence the risk of recurrence, also known as prognostic factors. These factors range from patient-, tumor- and treatment-related characteristics to geographic and socioeconomic factors. In addition to these factors, biological markers, such as genetic alterations, should be studied more intensively as these markers may be able to better identify patients at risk of tumor recurrence. Abstract In high-income countries, the overall survival of children with Wilms tumors (WT) is ~90%. However, overall, 15% of patients experience tumor recurrence. The adverse prognostic factors currently used for risk stratification (advanced stage, high risk histology, and combined loss of heterozygosity at 1p and 16q in chemotherapy-naïve WTs) are present in only one third of these cases, and the significance of these factors is prone to change with advancing knowledge and improved treatment regimens. Therefore, we present a comprehensive, updated overview of the published prognostic variables for WT recurrence, ranging from patient-, tumor- and treatment-related characteristics to geographic and socioeconomic factors. Improved first-line treatment regimens based on clinicopathological characteristics and advancing knowledge on copy number variations unveil the importance of further investigating the significance of biological markers for WT recurrence in international collaborations.
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Affiliation(s)
- Alissa Groenendijk
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Correspondence:
| | - Filippo Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Ronald R. de Krijger
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jarno Drost
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Oncode Institute, 3584 CS Utrecht, The Netherlands
| | - Jesper Brok
- Department of Pediatric Oncology and Hematology, Rigshospitalet, 2100 Copenhagen, Denmark;
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Daniela Perotti
- Molecular Bases of Genetic Risk and Genetic Testing Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
| | | | - Jan Godziński
- Department of Pediatric Surgery, Marciniak Hospital, Fieldorfa 2, 54-049 Wroclaw, Poland;
- Department of Pediatric Traumatology and Emergency Medicine, Wroclaw Medical University, Bujwida 44a, 50-345 Wroclaw, Poland
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg, Germany;
| | - James I. Geller
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA;
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg, Germany;
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
| | - Annelies M. C. Mavinkurve-Groothuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
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15
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Sereke SG, Sahal AO, Mboizi V, Bongomin F. Synchronous bilateral Wilms' tumor with liver metastasis. BMC Urol 2021; 21:91. [PMID: 34112148 PMCID: PMC8193872 DOI: 10.1186/s12894-021-00859-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background Wilms’ tumor (nephroblastoma) is mostly unilateral; however, bilateral Wilms’ tumors are seen in about 5–8% of patients. This can be synchronous or metachronous. It is uncommon to get liver metastasis from bilateral Wilms’ tumor. Case presentation An 8-year-old male Ugandan presented with a history of abdominal swelling and flank pains for 1 year. There was no history of hematuria. Both ultrasound and computed tomography of the abdomen demonstrated multiple solid lesions in both kidneys and a huge solid mass in segments V, VI, VII and VIII of the liver. Histological examination of renal biopsy specimen was favorable for chemotherapeutic regimens. However, following a multidisciplinary tumor board consensus, a nephron-sparing surgery was deemed unsuitable, and he was managed conservatively with chemotherapy (adriamycin and vincristine) with a palliative intent. Conclusions Metastatic bilateral Wilms’ tumor has a particularly poor prognosis. There are no clear evidence-based guidelines for the management of this rare presentation. This patient benefited from early palliative care and symptom management.
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Affiliation(s)
- Senai Goitom Sereke
- Department of Radiology and Radiotherapy, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Abdirahman Omar Sahal
- Department of Radiology and Radiotherapy, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Vincent Mboizi
- Department of Radiology and Radiotherapy, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Bongomin
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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16
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Dávila Fajardo R, Furtwängler R, van Grotel M, van Tinteren H, Pasqualini C, Pritchard-Jones K, Al-Saadi R, de Camargo B, Ramírez Villar GL, Graf N, Muracciole X, Melchior P, Saunders D, Rübe C, van den Heuvel-Eibrink MM, Janssens GO, Verschuur AC. Outcome of Stage IV Completely Necrotic Wilms Tumour and Local Stage III Treated According to the SIOP 2001 Protocol. Cancers (Basel) 2021; 13:cancers13050976. [PMID: 33652659 PMCID: PMC7956604 DOI: 10.3390/cancers13050976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 01/02/2023] Open
Abstract
Simple Summary Around 15–20% of all Wilms tumour (WT) patients present with metastatic disease. Approximately 10% of these patients achieve complete necrosis after preoperative chemotherapy, which is associated with a favourable prognosis. The aim of this observational study is to describe the outcome of metastatic patients with completely necrotic (low-risk histology), local stage III WT treated according to the SIOP 2001 protocol, whether or not postoperative radiotherapy was applied. Abstract Objective: Wilms tumour (WT) patients with a localised completely necrotic nephroblastoma after preoperative chemotherapy are a favourable outcome group. Since the introduction of the SIOP 2001 protocol, the SIOP– Renal Tumour Study Group (SIOP–RTSG) has omitted radiotherapy for such patients with low-risk, local stage III in an attempt to reduce treatment burden. However, for metastatic patients with local stage III, completely necrotic WT, the recommendations led to ambiguous use. The purpose of this descriptive study is to demonstrate the outcomes of patients with metastatic, completely necrotic and local stage III WT in relation to the application of radiotherapy or not. Methods and materials: all metastatic patients with local stage III, completely necrotic WT after 6 weeks of preoperative chemotherapy who were registered in the SIOP 2001 study were included in this analysis. The pattern of recurrence according to the usage of radiation treatment and 5 year event-free survival (EFS) and overall survival (OS) was analysed. Results: seven hundred and three metastatic WT patients were registered in the SIOP 2001 database. Of them, 47 patients had a completely necrotic, local stage III WT: 45 lung metastases (11 combined localisations), 1 liver/peritoneal, and 1 tumour thrombus in the renal vein and the inferior vena cava with bilateral pulmonary arterial embolism. Abdominal radiotherapy was administered in 29 patients (62%; 29 flank/abdominal irradiation and 9 combined with lung irradiation). Eighteen patients did not receive radiotherapy. Median follow-up was 6.6 years (range 1–151 months). Two of the 47 patients (4%) developed disease recurrence in the lung (one combined with abdominal relapse) and eventually died of the disease. Both patients had received abdominal radiotherapy, one of them combined with lung irradiation. Five-year EFS and OS were 95% and 95%, respectively. Conclusions: the outcome of patients with stage IV, local stage III, completely necrotic Wilms tumours is excellent. Our results suggest that abdominal irradiation in this patient category may not be of added value in first-line treatment, consistent with the current recommendation in the SIOP–RTSG 2016 UMBRELLA protocol.
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Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.v.G.); (M.M.v.d.H.-E.)
- Correspondence: ; Tel.: +31-(0)88-756-7898
| | - Rhoikos Furtwängler
- Department of Paediatric Oncology and Haematology, University Hospital of Saarland, 66421 Homburg, Germany; (R.F.); (N.G.)
| | - Martine van Grotel
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.v.G.); (M.M.v.d.H.-E.)
| | - Harm van Tinteren
- Trial and Data Center, Princess Maxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands;
| | - Claudia Pasqualini
- Department of Paediatric Oncology, Institute Gustave Roussy, CEDEX, 94805 Villejuif, France;
| | - Kathy Pritchard-Jones
- Developmental Biology & Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; (K.P.-J.); (R.A.-S.)
| | - Reem Al-Saadi
- Developmental Biology & Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK; (K.P.-J.); (R.A.-S.)
| | - Beatriz de Camargo
- Research Center, Brazilian National Cancer Institute, Rio de Janeiro 20230-240, Brazil;
| | - Gema L. Ramírez Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain;
| | - Norbert Graf
- Department of Paediatric Oncology and Haematology, University Hospital of Saarland, 66421 Homburg, Germany; (R.F.); (N.G.)
| | - Xavier Muracciole
- Department of Radiation Oncology, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France;
| | - Patrick Melchior
- Department of Radiation Oncology, University Hospital of Saarland, 66421 Homburg, Germany; (P.M.); (C.R.)
| | | | - Christian Rübe
- Department of Radiation Oncology, University Hospital of Saarland, 66421 Homburg, Germany; (P.M.); (C.R.)
| | | | - Geert O. Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.v.G.); (M.M.v.d.H.-E.)
| | - Arnauld C. Verschuur
- Department of Paediatric Oncology, La Timone Children’s Hospital, Assistance Publique Hôpitaux de Marseille, 13005 Marseille, France;
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17
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Long-term Outcome in Children with Wilms’ Tumor; Experience of a Single Center for Two Decades. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.102113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Wilms’ tumor (nephroblastoma) is the major renal cancer in children. Objectives: The aim of this study was to assess the individuality of Wilms’ tumor and the consequences of management attained in our referral subspecialty center. Methods: In this study, we composed the data of children with Wilms’ tumor in 2 decades; 55 cases between 1992 and 2002 and 49 patients between 2006 and 2016 were diagnosed with Wilms’ tumor. Demographic characters, a form of presentation, tumor stage, related underlying disease, histopathology consequences, type of management, and the survival rates were assessed. Results: In the first decade, 24 patients were females and 31 were males (M/F = 1.2); in the other groups, 30 were females and 19 were males (M/F = 0.61). The mean age was 45.2 months at the time of diagnosis for the first group and the mean age was 36 months for the other group. In the first decade, the surgical stage after the operation was as follows: stage I (32.7%), stage II (16.36%), stage III (38.1%), stage IV (9%), and stage V (1.8%) who did not operate. In second decade, 49 patients were as follows: stage I (14.3%), stage II (40.8%), stage III (24.5%), stage IV (10.2%), and stage V (10.2%). In 54.5% of the first group, histology was favorable, and in 43.6% of the first group, histology was unfavorable; in the second group, 95.4% were the favorable type. The patients were managed based on protocols of the National Wilms’ Tumor Study. In the first decade, relapse-free was 71% and 4-year survival rates were estimated at 86%, and in the second decade, pulmonary metastasis was observed at 28.6%, liver metastasis in 2.3%, recurrence in 5%, and 4-year survival rates were estimated at 90%. Conclusions: This study demonstrated development in the management of children with Wilms’ tumor in recent 20 years, with comparable relapse-free and survival rates to the National Wilms’ Tumor study. But with more adjustment in treatment protocols, the superior outcome will be attainable.
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18
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Lopyan NM, Ehrlich PF. Surgical Management of Wilms Tumor (Nephroblastoma) and Renal Cell Carcinoma in Children and Young Adults. Surg Oncol Clin N Am 2021; 30:305-323. [PMID: 33706902 DOI: 10.1016/j.soc.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article reviews the epidemiology, pathophysiology, clinical presentation, and multimodality management of Wilms tumors and renal cell carcinoma in pediatric and young adults. Key renal Société Internationale d'Oncologie Pédiatrique and Children Oncology Group studies are presented. The article reviews the common staging systems and risk-adapted treatment strategies with particular attention to the surgical management.
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Affiliation(s)
- Natalie M Lopyan
- C.S. Mott Children's Hospital Section of Pediatric Surgery, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA
| | - Peter F Ehrlich
- University of Michigan, C.S. Mott Children's Hospital Section of Pediatric Surgery, 1540 East Hospital Drive, SPC 4811, Ann Arbor, MI 48109, USA.
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Jain V, Dhua A, Agarwala S, Bakhshi S, Srinivas M, Iyer VK, Mathur S, Jana M, Kandasamy D, Biswas A, Bhatnagar V, Bajpai M. Outcome of Children with Stage IV Wilms Tumor - Our Experience of 15 Years. J Indian Assoc Pediatr Surg 2020; 25:372-377. [PMID: 33487940 PMCID: PMC7815034 DOI: 10.4103/jiaps.jiaps_168_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/16/2019] [Accepted: 01/11/2020] [Indexed: 12/02/2022] Open
Abstract
Context: Stage IV Wilms tumor is associated with poor prognosis, and recent changes in management have been suggested based on genetic markers and response to chemotherapy in this subgroup of patients. Objective: The objective was to evaluate the outcomes of children with Stage IV Wilms tumor who were managed with the AIIMS-WT-99 protocol. Materials and Methods: All the children with Stage IV Wilms tumor who were managed by us from October 2000 to December 2012 were included in the study. All the patients who had received primary treatment elsewhere were excluded from the study. All patients were managed as per the AIIMS-WT-99 protocol. After appropriate investigations, tumors that were deemed resectable underwent an upfront surgery. Unresectable and inoperable tumors received chemotherapy after cytological confirmation of the diagnosis. Chemotherapy was administered as per the NWTS-5 study. Pulmonary and flank radiotherapy was advised to all patients. Patients with poor response to chemotherapy or with recurrence were managed with an alternative chemotherapy regimen. The outcomes that were assessed the 4-year overall survival (OS) and the 4-year event-free survival (EFS). Statistical Analysis Used: Kaplan–Meier survival estimates. Results: During the study period, 219 patients with Wilms tumor were treated. Of these, 36 (16.4%) had Stage IV disease, and they formed the study group. The 4-year OS was 48% with a mean survival time of 59 months limited to 115 months (95% confidence interval: 41.3–75.9 months). The 4-year EFS was 42.4%. Patients with liver metastases had a poor outcome, whereas patients with good response to chemotherapy had a good outcome. Conclusion: Stage IV Wilms had a poor prognosis, and the survival rates in the index study are lower than those quoted in the literature. Although the exact reason for this poor result eludes us, these patients may benefit from the intensification of chemotherapy.
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Affiliation(s)
- Vishesh Jain
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. BRA Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - M Srinivas
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Venkateswaran K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ahitagni Biswas
- Department of Radiotherapy, Dr. BRA Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Veereshwar Bhatnagar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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20
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Liné A, Sudour-Bonnange H, Languillat-Fouquet V, Brisse H, Irtan S, Verschuur A, Sarnacki S, Thébaud E, Coulomb-L'Hermine A, Notz-Carrère A, Michon J, Tabone MD, Boulanger C, Pellier I, Freycon C, Audry G, Dijoud F, Morelle M, Bergeron C, Pasqualini C. Liver metastasis at diagnosis in children with nephroblastoma enrolled in SIOP2001 protocol: A French multicentric study. Pediatr Blood Cancer 2020; 67:e28201. [PMID: 32207555 DOI: 10.1002/pbc.28201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Liver metastases are rare in children with Wilms tumor (WT), and their impact on the outcome is unclear. PATIENTS AND METHODS The French cohort of patients with WT presenting liver metastases at diagnosis and enrolled in the International Society of Pediatric Oncology (SIOP) 2001 study was reviewed. RESULTS From 2002 to 2012, 906 French patients were enrolled in the SIOP2001 trial. Among them, 131 (14%) presented with stage IV WT and 18 (1.9%) had liver metastases at diagnosis. Isolated liver metastases were displayed in four of them. After preoperative chemotherapy, persistent liver disease was reported in 14/18 patients, and 13 of them underwent metastasectomy after nephrectomy. In resected liver lesions, the same histology of the primary tumor was reported for three patients, blastemal cells without anaplasia were identified in one patient with DA-WT, and post-chemotherapy necrosis/fibrosis was identified for the other 10 patients. For the four patients who had liver and lung surgery, both sites had nonviable cells with post-chemotherapy necrosis/fibrosis. Six patients had hepatic radiotherapy. Sixteen patients achieved primary complete remission and were alive at the last follow-up (median follow-up: 6.4 years). The only two deceased patients presented diffuse anaplasia histology. The five-year EFS and OS were 83% (60%-94%) and 88% (66%-97%), respectively. CONCLUSION Liver involvement does not appear to be an adverse prognostic factor in metastatic WT. The role of hepatic surgery and radiotherapy remains unclear, and should be carefully considered in case of persistent liver metastases, according to histology and radiological response to other metastatic sites.
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Affiliation(s)
- Antoine Liné
- Department of Pediatric Surgery, University Hospital Center of Reims, Reims, France
| | | | | | - Hervé Brisse
- Department of Radiology, Curie Institute, Paris, France
| | - Sabine Irtan
- Department of Pediatric Surgery, Armand Trousseau Hospital, APHP, Paris, France
| | - Arnauld Verschuur
- Pediatric Hematology-Oncology Department, La Timone Hospital, AP-HM, Marseille, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Necker Enfants Malades Hospital, Paris, France
| | - Estelle Thébaud
- Pediatric Onco-Hematology Department, University Hospital Center of Nantes, Nantes, France
| | | | - Anne Notz-Carrère
- Pediatric Onco-Hematology Department, University Hospital Center of Bordeaux, Bordeaux, France
| | - Jean Michon
- Pediatric Onco-Hematology Department, Curie Institute, Paris, France
| | | | - Cécile Boulanger
- Pediatric Hematology-Oncology Department, University Hospital Center of Toulouse, Toulouse, France
| | - Isabelle Pellier
- Pediatric Hematology-Oncology Department, University Hospital Center of Angers, Angers, France
| | - Claire Freycon
- Pediatric Hematology-Oncology Department, University Hospital Center of Grenoble, Grenoble, France
| | - Georges Audry
- Department of Pediatric Surgery, Armand Trousseau Hospital, APHP, Paris, France
| | | | - Magali Morelle
- Department of Statistic, Centre Léon Bérard, Lyon, France
| | - Christophe Bergeron
- Pediatric Onco-Hematology Department, Centre Leon Bérard/ IHOPE, Lyon, France
| | - Claudia Pasqualini
- Children and Adolescents Oncology Department, Gustave Roussy, Villejuif, France
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21
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Elayadi M, Magdy S, Khalil E, Zekri W. Management and outcome of pediatric metastatic Wilms' tumor at the National Cancer Institute, Egypt. J Egypt Natl Canc Inst 2020; 32:19. [PMID: 32372204 DOI: 10.1186/s43046-020-00031-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Wilms' tumor (WT) is the most common renal malignant tumor of childhood. Metastatic WT has a worse prognosis than localized disease. This study aims to assess the clinical outcome and different prognostic factors that influence treatment outcome of pediatric metastatic WT cases treated at National Cancer Institute (NCI), Egypt, between January 2008 and December 2015. Medical records were retrospectively reviewed for clinical, radiological and histopathological data, treatment received, and survival outcome. RESULTS In the specified study period, 24/103 (23.3%) patients with WT were metastatic at presentation. The mean age was 5.25 ± 2.87 years (range 2.0-12.7). Abdominal swelling/mass was the commonest presentation (70.8%). Only 3 patients (12.5%) had combined lung and liver metastases while 21 patients (87.5%) had pulmonary-only metastases. All patients had favorable histology tumors with no anaplasia. Nine patients (37.5%) underwent upfront nephrectomy. Majority of patients (91.7%) had local stage III disease. Surgical complications were reported in 4 patients; 3 of them had up-front nephrectomy. Only 7/21 patients achieved rapid complete response of pulmonary nodules after 6 weeks of chemotherapy (CTH), and they had a better survival outcome. Patients were followed up till December 2017. Thirteen patients (54.1%) experienced events during the study period including 5 relapses, 6 cases with disease progression, and 2 patients died out of sepsis. The 3-year event-free and overall survival rates were 48.2% and 54.2%, respectively. CONCLUSION Neo-adjuvant CTH followed by delayed nephrectomy seems more suitable approach in our institute. Pulmonary response to neo-adjuvant CTH appears to be a strong predictor for outcome.
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Affiliation(s)
- Moatasem Elayadi
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, El-khalig Square, Kasr El-Aini St., Cairo, 11796, Egypt
| | - Sarah Magdy
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, El-khalig Square, Kasr El-Aini St., Cairo, 11796, Egypt
| | - Ehab Khalil
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Wael Zekri
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, El-khalig Square, Kasr El-Aini St., Cairo, 11796, Egypt.
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22
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Murphy AJ, Chen X, Pinto EM, Williams JS, Clay MR, Pounds SB, Cao X, Shi L, Lin T, Neale G, Morton CL, Woolard MA, Mulder HL, Gil HJ, Rehg JE, Billups CA, Harlow ML, Dome JS, Houghton PJ, Easton J, Zhang J, George RE, Zambetti GP, Davidoff AM. Forty-five patient-derived xenografts capture the clinical and biological heterogeneity of Wilms tumor. Nat Commun 2019; 10:5806. [PMID: 31862972 PMCID: PMC6925259 DOI: 10.1038/s41467-019-13646-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 11/19/2019] [Indexed: 12/22/2022] Open
Abstract
The lack of model systems has limited the preclinical discovery and testing of therapies for Wilms tumor (WT) patients who have poor outcomes. Herein, we establish 45 heterotopic WT patient-derived xenografts (WTPDX) in CB17 scid-/- mice that capture the biological heterogeneity of Wilms tumor (WT). Among these 45 total WTPDX, 6 from patients with diffuse anaplastic tumors, 9 from patients who experienced disease relapse, and 13 from patients with bilateral disease are included. Early passage WTPDX show evidence of clonal selection, clonal evolution and enrichment of blastemal gene expression. Favorable histology WTPDX are sensitive, whereas unfavorable histology WTPDX are resistant to conventional chemotherapy with vincristine, actinomycin-D, and doxorubicin given singly or in combination. This WTPDX library is a unique scientific resource that retains the spectrum of biological heterogeneity present in WT and provides an essential tool to test targeted therapies for WT patient groups with poor outcomes. The progress in pre-clinical drug discovery for Wilms tumor (WT) is limited by a lack of disease models. Here, the authors develop 45 heterotopic WT patient-derived xenografts including several anaplastic models that recapitulate the biological heterogeneity of WT, and propose this as a resource for evaluating future therapeutics for WT.
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Affiliation(s)
- Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA. .,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave. 2nd floor, Memphis, TN, 38163, USA.
| | - Xiang Chen
- Department of Computational Biology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Emilia M Pinto
- Department of Pathology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Justin S Williams
- Department of Computational Biology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Michael R Clay
- Department of Pathology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Stanley B Pounds
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Xueyuan Cao
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,College of Nursing, University of Tennessee Health Science Center, 920 Madison Ave, Memphis, TN, 38163, USA
| | - Lei Shi
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Tong Lin
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Geoffrey Neale
- Hartwell Center for Bioinformatics and Biotechnology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Christopher L Morton
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Mary A Woolard
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Heather L Mulder
- Department of Computational Biology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Hyea Jin Gil
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Jerold E Rehg
- Department of Pathology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Catherine A Billups
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Matthew L Harlow
- Department of Pediatric Hematology and Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, 450 Brookline Avenue, Room D640E, Boston, MA, 02215, USA
| | - Jeffrey S Dome
- Division of Oncology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Peter J Houghton
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center, 8403 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - John Easton
- Department of Computational Biology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Rani E George
- Department of Pediatric Hematology and Oncology, Dana-Farber Cancer Institute and Boston Children's Hospital, Harvard Medical School, 450 Brookline Avenue, Room D640E, Boston, MA, 02215, USA
| | - Gerard P Zambetti
- Department of Pathology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave. 2nd floor, Memphis, TN, 38163, USA
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23
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Aldrink JH, Heaton TE, Dasgupta R, Lautz TB, Malek MM, Abdessalam SF, Weil BR, Rhee DS, Baertschiger R, Ehrlich PF. Update on Wilms tumor. J Pediatr Surg 2019; 54:390-397. [PMID: 30270120 PMCID: PMC7542630 DOI: 10.1016/j.jpedsurg.2018.09.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/28/2018] [Accepted: 09/14/2018] [Indexed: 02/07/2023]
Abstract
This article reviews of the current evidence-based treatment standards for children with Wilms tumor. In this article, a summary of recently completed clinical trials by the Children's Oncology Group is provided, the current diagnostic evaluation and surgical standards are discussed, and the surgical impact on current risk stratification for patients with Wilms tumor is highlighted. LEVEL OF EVIDENCE: This is a review article of previously published and referenced LEVEL 1 studies, but also includes expert opinion LEVEL V, represented by the American Pediatric Surgical Association Cancer Committee.
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Affiliation(s)
- Jennifer H Aldrink
- Department of Surgery, Division of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
| | - Todd E Heaton
- Department of Surgery, Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Timothy B Lautz
- Department of Surgery, Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marcus M Malek
- Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Shahab F Abdessalam
- Department of Surgery, Division of Pediatric Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Brent R Weil
- Department of Surgery, Division of Pediatric Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Daniel S Rhee
- Depatment of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Reto Baertschiger
- Department of Surgery, Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Peter F Ehrlich
- Department of Surgery, Division of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
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24
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Biological Drivers of Wilms Tumor Prognosis and Treatment. CHILDREN-BASEL 2018; 5:children5110145. [PMID: 30373137 PMCID: PMC6262554 DOI: 10.3390/children5110145] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022]
Abstract
Prior to the 1950s, survival from Wilms tumor (WT) was less than 10%. Today, a child diagnosed with WT has a greater than 90% chance of survival. These gains in survival rates from WT are attributed largely to improvements in multimodal therapy: Enhanced surgical techniques leading to decreased operative mortality, optimization of more effective chemotherapy regimens (specifically, dactinomycin and vincristine), and inclusion of radiation therapy in treatment protocols. More recent improvements in survival, however, can be attributed to a growing understanding of the molecular landscape of Wilms tumor. Particularly, identification of biologic markers portending poor prognosis has facilitated risk stratification to tailor therapy that achieves the best possible outcome with the least possible toxicity. The aim of this review is to (1) outline the specific biologic markers that have been associated with prognosis in WT and (2) provide an overview of the current use of biologic and other factors to stratify risk and assign treatment accordingly.
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25
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Dix DB, Seibel NL, Chi YY, Khanna G, Mullen EA, Geller JI, Kalapurakal JA, Ehrlich PF, Malogolowkin MH, Fernandez CV, Dome JS. Reply to D.M. Green. J Clin Oncol 2018; 36:JCO1800659. [PMID: 30212299 DOI: 10.1200/jco.18.00659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- David B Dix
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Nita L Seibel
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Yueh-Yun Chi
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Geetika Khanna
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Elizabeth A Mullen
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - James I Geller
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - John A Kalapurakal
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Peter F Ehrlich
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Marcio H Malogolowkin
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Conrad V Fernandez
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jeffrey S Dome
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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Dix DB, Seibel NL, Chi YY, Khanna G, Gratias E, Anderson JR, Mullen EA, Geller JI, Kalapurakal JA, Paulino AC, Perlman EJ, Ehrlich PF, Malogolowkin M, Gastier-Foster JM, Wagner E, Grundy PE, Fernandez CV, Dome JS. Treatment of Stage IV Favorable Histology Wilms Tumor With Lung Metastases: A Report From the Children's Oncology Group AREN0533 Study. J Clin Oncol 2018; 36:1564-1570. [PMID: 29659330 DOI: 10.1200/jco.2017.77.1931] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose The National Wilms Tumor Study (NWTS) treatment of favorable histology Wilms tumor with lung metastases was vincristine/dactinomycin/doxorubicin (DD4A) and lung radiation therapy (RT). The AREN0533 study applied a new risk stratification and treatment strategy to improve event-free survival (EFS) while reducing exposure to lung RT. Methods Patients with favorable histology Wilms tumor and isolated lung metastases showing complete lung nodule response (CR) after 6 weeks of DD4A continued receiving chemotherapy without lung RT. Patients with incomplete response (IR) or loss of heterozygosity at chromosomes 1p/16q received lung RT and four cycles of cyclophosphamide/etoposide in addition to DD4A drugs (Regimen M). AREN0533 was designed to preserve a 4-year EFS of 85% for lung nodule CR and improve 4-year EFS from 75% to 85% for lung nodule IR. Results Among 292 assessable patients, 133 had CR and 159 had IR. For patients with CR, 4-year EFS and overall survival (OS) estimates were 79.5% (95% CI, 71.2% to 87.8%) and 96.1% (95% CI, 92.1% to 100%), respectively. Expected versus observed event rates were 15% and 20.2% ( P = .052), respectively. For patients with IR, 4-year EFS and OS estimates were 88.5% (95% CI, 81.8% to 95.3%) and 95.4% (95% CI, 90.9% to 99.8%), respectively. Expected versus observed event rates were 25% and 12.2% ( P < .001), respectively. Overall, 4-year EFS and OS were 85.4% (95% CI, 80.5% to 90.2%) and 95.6% (95% CI, 92.8% to 98.4%) compared with 72.5% (95% CI, 66.9% to 78.1%; P < .001) and 84.0% (95% CI, 79.4% to 88.6%; P < .001), respectively, in the predecessor NWTS-5 study. Conclusion Excellent OS was achieved after omission of primary lung RT in patients with lung nodule CR, although there were more events than expected. EFS was significantly improved, with excellent OS, in patients with lung nodule IR using four cycles of cyclophosphamide/etoposide in addition to DD4A drugs. The overall AREN0533 treatment strategy yielded EFS and OS estimates that were superior to previous studies.
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Affiliation(s)
- David B Dix
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Nita L Seibel
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Yueh-Yun Chi
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Geetika Khanna
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Eric Gratias
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - James R Anderson
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth A Mullen
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - James I Geller
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - John A Kalapurakal
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Arnold C Paulino
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth J Perlman
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Peter F Ehrlich
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Marcio Malogolowkin
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Julie M Gastier-Foster
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth Wagner
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Paul E Grundy
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Conrad V Fernandez
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Jeffrey S Dome
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
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Abstract
The objective of this article is to present an overview of recent trends in the management of Wilms’ tumor. With improved survival rates in the past few decades, critical long-term adverse therapy effects (such as renal insufficiency, secondary malignancies, and heart failure) and prevention measures (i.e. nephron-sparing surgery and minimizing the use of radiotherapy) have gained worldwide attention. Specific disease biomarkers that could help stratify high-risk from low-risk patients, and therefore fine-tune management, are in great demand. Ultimately, we aim to enhance clinical outcomes and maintain or improve current survival rates while avoiding undesirable treatment side effects and minimizing the exposure and intensity of chemotherapy and radiotherapy.
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Affiliation(s)
- Roberto I Lopes
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Armando Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
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Ehrlich PF, Hamilton TE, Gow K, Barnhart D, Ferrer F, Kandel J, Glick R, Dasgupta R, Naranjo A, He Y, Perlman EJ, Kalapurakal JA, Khanna G, Dome JS, Geller J, Mullen E. Surgical protocol violations in children with renal tumors provides an opportunity to improve pediatric cancer care: a report from the Children's Oncology Group. Pediatr Blood Cancer 2016; 63:1905-10. [PMID: 27229358 PMCID: PMC5030129 DOI: 10.1002/pbc.26083] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/31/2016] [Accepted: 04/26/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the frequency and characteristics of surgical protocol violations (SPVs) among children undergoing surgery for renal tumors who were enrolled on the Children's Oncology Group (COG) renal tumor biology and classification study AREN03B2. METHODS AREN03B2 was opened in February 2006, and as on March 31, 2013, there were 3,664 eligible patients. The surgical review forms for 3,536 patients with unilateral disease were centrally reviewed for SPVs. The frequency, type, number of violations, institutional prevalence, and quartiles for SPVs were assessed. RESULTS Of the 3,536 patients, there were a total of 505 with at least one SPV (564 total SPVs reported), for an overall incidence of 14.28%. The types of SPVs included a lack of lymph node sampling in 365 (64.7%), avoidable spill in 61 (10.8%), biopsy immediately before nephrectomy in 89 (15.8%), an incorrect abdominal incision in 32 (5.7%), and unnecessary resection of organs in 17 (3.0%). The SPVs occurred in 163 of 215 participating institutions (75.8%). For centers with at least one SPV, the mean number of SPVs reported was 3.10 ± 2.39 (mean ± standard deviation). The incidence of protocol violation per institution ranged from 0 to 67%. Centers with an average of ≤1 case/year had an incidence of SPVs of 12.2 ± 3.8%, those with an average of >1 to <4 cases/year had an incidence of SPVs of 16.4 ± 3.6%, and those with an average of ≥4 cases/year had an incidence of SPVs of 12.6 ± 5.5% (P > 0.05). CONCLUSIONS SPVs that potentially result in additional exposure to chemotherapy and radiation therapy are not uncommon in children undergoing resection of renal malignancies.
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Affiliation(s)
| | - Thomas E. Hamilton
- Dana Farber Cancer Institute, Boston Children's Hospital, Boston, MA, USA
| | - Kenneth Gow
- Seattle Children's Hospital, Seattle, WA, USA
| | | | | | - Jessica Kandel
- Comer Children's Hospital University of Chicago, Chicago IL, USA
| | - Richard Glick
- Steven and Alexandra Cohen Medical Center of New York, New York, NY, USA
| | | | - Arlene Naranjo
- Children's Oncology Group (COG) Statistics and Data Center (SDC), University of Florida, Gainesville, FL, USA
| | - Ying He
- Clarkson University, Potsdam NY, USA
| | - Elizabeth J. Perlman
- Luire Children's Hospital Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - John A. Kalapurakal
- Luire Children's Hospital Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - James Geller
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Elizabeth Mullen
- Dana Farber Cancer Institute, Boston Children's Hospital, Boston, MA, USA
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29
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Abstract
BACKGROUND Treatment results of Wilms tumors have been impressively improved over the past 50 years resulting in a stage-independent overall survival of greater than 90%. However, unsatisfying treatment results still remain in children with high-risk tumors and tumor relapses. MATERIALS AND METHODS This review highlights the current concepts of Wilms tumor surgery as a cornerstone of the treatment strategy for this malignancy. A selective literature review focusing on the past 5 years served as the basis for this article. RESULTS Nephron-sparing surgery is associated with an analogue outcome compared to tumor nephrectomy in unilateral Wilms tumors. The surgical panel of the International Society of Pediatric Oncology (SIOP) group has recently introduced a novel nomenclature for organ-preserving resection procedures in order to facilitate a prospective comparison of data. The minimally invasive approach represents an alternative technique with adequate outcome. In bilateral disease, nephron-sparing procedures are gold standard. Complete resection of lung and liver metastases has a significant impact on patients' survival. CONCLUSIONS Surgical guidelines for nephron-sparing surgery and minimally invasive tumor nephrectomy need to be established and implemented within newly formulated treatment protocols of the different national and international treatment trials. Risk stratification of patients needs to be more individualized with the aim of reducing late effects while at least maintaining the same survival rates. The unsatisfying treatment results of tumor relapses-associated with low patient numbers within the different trials-emphasize the need for international collaboration.
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Affiliation(s)
- J Fuchs
- Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 03, 72076, Tübingen, Deutschland.
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Fernandez-Pineda I, Sandoval JA, Davidoff AM. Hepatic metastatic disease in pediatric and adolescent solid tumors. World J Hepatol 2015; 7:1807-1817. [PMID: 26207162 PMCID: PMC4506938 DOI: 10.4254/wjh.v7.i14.1807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/21/2015] [Accepted: 05/28/2015] [Indexed: 02/06/2023] Open
Abstract
The management of hepatic metastatic disease from solid tumors in adults has been extensively described and resection of metastatic liver lesions from colorectal adenocarcinoma, renal adenocarcinoma, breast cancer, testicular cancer, and neuroendocrine tumors (NET) have demonstrated therapeutic benefits in select patients. However, there are few reports in the literature on the management of hepatic metastatic disease in the pediatric and adolescent populations and the effectiveness of hepatic metastasectomy. This may be due to the much lower incidence of pediatric malignancies and the higher chemosensitivity of childhood tumors which make hepatic metastasectomy less likely to be required. We review liver involvement with metastatic disease from the main pediatric solid tumors, including neuroblastoma and Wilms tumor focusing on the management and treatment options. We also review other solid malignant tumors which may have liver metastases including germ cell tumors, gastrointestinal stromal tumors, osteosarcoma, desmoplastic small round cell tumors and NET. However, these histological subtypes are so rare in the pediatric and adolescent populations that the exact incidence and best management of hepatic metastatic disease are unknown and can only be extrapolated from adult series.
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31
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Kieran K, Ehrlich PF. Current surgical standards of care in Wilms tumor. Urol Oncol 2015; 34:13-23. [PMID: 26122713 DOI: 10.1016/j.urolonc.2015.05.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Wilms tumor (WT) is the second most common abdominal tumor in children. METHODS This chapter discusses surgical considerations for the management of unilateral and bilateral WT. RESULTS Currently, survival exceeds 90%, owing to multicenter studies under the auspices of the Children's Oncology Group and Société Internationale d'Oncologie Pédiatrique. Surgical excision remains the mainstay of oncologic control and is also crucial for proper staging of disease in order to direct adjuvant therapy and limit treatment-related morbidity. CONCLUSIONS Careful attention must be paid to proper disease staging, upfront and adjuvant therapy, and surgical technique in order to optimize oncologic outcomes while minimizing short- and long-term morbidity.
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Affiliation(s)
- Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98109.
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Savage P. Clinical observations on chemotherapy curable malignancies: unique genetic events, frozen development and enduring apoptotic potential. BMC Cancer 2015; 15:11. [PMID: 25605631 PMCID: PMC4308945 DOI: 10.1186/s12885-015-1006-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 12/31/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A select number of relatively rare metastatic malignancies comprising trophoblast tumours, the rare childhood cancers, germ cells tumours, leukemias and lymphomas have been routinely curable with chemotherapy for more than 30 years. However for the more common metastatic malignancies chemotherapy treatment frequently brings clinical benefits but cure is not expected. Clinically this clear divide in outcome between the tumour types can appear at odds with the classical theories of chemotherapy sensitivity and resistance that include rates of proliferation, genetic development of drug resistance and drug efflux pumps. We have looked at the clinical characteristics of the chemotherapy curable malignancies to see if they have any common factors that could explain this extreme differential sensitivity to chemotherapy. DISCUSSION It has previously been noted how the onset of malignancy can leave malignant cells fixed with some key cellular functions remaining frozen at the point in development at which malignant transformation occurred. In the chemotherapy curable malignancies the onset of malignancy is in each case closely linked to one of the unique genetic events of; nuclear fusion for molar pregnancies, choriocarcinoma and placental site trophoblast tumours, gastrulation for the childhood cancers, meiosis for testicular cancer and ovarian germ cell tumours and VDJ rearrangement and somatic hypermutation for acute leukemia and lymphoma. These processes are all linked to natural periods of supra-physiological apoptotic potential and it appears that the malignant cells arising from them usually retain this heightened sensitivity to DNA damage. To investigate this hypothesis we have examined the natural history of the healthy cells during these processes and the chemotherapy sensitivity of malignancies arising before, during and after the events. To add to the debate on chemotherapy resistance and sensitivity, we would argue that malignancies can be functionally divided into 2 groups. Firstly those that arise in cells with naturally heightened apoptotic potential as a result of their proximity to the unique genetic events, where the malignancies are generally chemotherapy curable and then the more common malignancies that arise in cells of standard apoptotic potential that are not curable with classical cytotoxic drugs.
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Affiliation(s)
- Philip Savage
- BCCA Vancouver Island, 2410 Lee Avenue, Victoria, BC, V8R 6V5, Canada.
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Abstract
PURPOSE OF REVIEW Outcomes for children with cancer have steadily improved and the long-term survival for most early-stage childhood malignancies is now greater than 90%. On the contrary, the prognosis for children with metastatic cancer, though significantly improved from a generation ago, is generally still very disappointing. Surgery continues to play a role in the increasingly aggressive treatment of children with metastatic disease with the ultimate goal of prolonging survival and improving quality of life. RECENT FINDINGS Most childhood tumors are relatively rare and are therefore studied using a multi-institutional cooperative group model that standardizes protocols and pools resources and data, accounting for the remarkable progress that has been made in the care of children with cancer. In some cases, this has also allowed us to recognize the utility of certain surgical therapies and the need to further study others. SUMMARY Modern surgery and critical care allow us to consider offering children with metastatic disease more aggressive surgical options in circumstances where the data suggest the potential for long-term survival. In situations where data are lacking, children might be offered a surgical option as part of an ongoing trial.
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Affiliation(s)
- Peter Mattei
- Department of Surgery, The University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
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Abstract
Malignant tumors of the liver comprise a relatively small fraction of the total number of pediatric malignancies. However, these tumors can be a significant cause of morbidity and mortality, and there have been significant therapeutic gains during the past few decades through advances in systemic therapy and surgical treatment. Even in patients with advanced local disease, complete resection is now a possibility because of improvements in liver transplantation techniques. In this review, we will discuss the staging and treatment of common malignant tumors of the liver.
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Affiliation(s)
- Joshua N Honeyman
- Pediatric Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York 10065, USA
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Aronson DC, Maharaj A, Sheik-Gafoor MH, Hadley GP. The results of treatment of children with metastatic Wilms tumours (WT) in an African setting: do liver metastases have a negative impact on survival? Pediatr Blood Cancer 2012; 59:391-4. [PMID: 22315136 DOI: 10.1002/pbc.24080] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 12/27/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND From Africa, where socio-economic circumstances differ from the developed world, there are no data regarding the influence of liver metastases on survival of children with Wilms tumour. PROCEDURE One hundred fifty new patients with WT were seen between 2002 and 2010, 45 (30%) had metastases at diagnosis. Seven patients had bilateral disease with additional visceral metastases. Nine patients who developed liver metastases during treatment were excluded. The site of metastases and the results of pretreatment biopsies were retrieved. Neo-adjuvant chemotherapy was combined with nutritional resuscitation, and aggressive supportive care. Post-operative treatment was determined by stage and histology. RESULTS Liver metastases were present in 19 (42%) patients but were the sole metastatic site in only 4 (9%). Overall survival at 5 years was 58.5%. Event Free Survival was 54%. Thirty-three (73%) had favourable histology, nine unfavourable and undetermined in three. No influence of histology on outcome was evident. Three patients had resection of persistent liver metastases. The pattern of metastatic disease had no influence on outcome. Despite aggressive supportive care two patients (4%) died within a week of presentation. Two patients died of chemotoxicity and two of complications following biopsy. Eight patients (17%) were lost to follow-up of whom five were on palliative treatment only. CONCLUSIONS In Africa liver metastases do not appear to worsen the prognosis of children with Stage IV WT. Despite the poor socio-economic circumstances survival is comparable to other countries.
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Affiliation(s)
- Daniel C Aronson
- Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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Kalapurakal JA, Pokhrel D, Gopalakrishnan M, Zhang Y. Advantages of whole-liver intensity modulated radiation therapy in children with Wilms tumor and liver metastasis. Int J Radiat Oncol Biol Phys 2012; 85:754-60. [PMID: 22763026 DOI: 10.1016/j.ijrobp.2012.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 05/09/2012] [Accepted: 05/14/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE To demonstrate the dosimetric advantages of intensity modulated radiation therapy (IMRT) in children with Wilms tumor (WT) undergoing whole-liver (WL) RT. METHODS AND MATERIALS Computed tomography simulation scans of 10 children, either 3 (3D) or 4-dimensional (4D), were used for this study. The WL PTV was determined by the 3D or 4D liver volumes, with a margin of 1 cm. A total of 40 WL RT plans were performed: 10 each for left- and right-sided WT with IMRT and anteroposterior-posteroanterior (AP-PA) techniques. The radiation dose-volume coverage of the WL planning target volume (PTV), remaining kidney, and other organs were analyzed and compared. RESULTS The 95% dose coverage to WL PTV for left and right WT were as follows: 97% ± 4% (IMRT), 83% ± 8% (AP-PA) (P<.01) and 99% ± 1% (IMRT), 94% ± 5% (AP-PA) (P<.01), respectively. When 3D WL PTV was used for RT planning, the AP-PA technique delivered 95% of dose to only 78% ± 13% and 88% ± 8% of 4D liver volume. For left WT, the right kidney V15 and V10 for IMRT were 29% ± 7% and 55% ± 8%, compared with 61% ± 29% (P<.01) and 78% ± 25% (P<.01) with AP-PA. For right WT, the left kidney V15 and V10 were 0 ± 0 and 2% ± 3% for IMRT, compared with 25% ± 19% (P<.01) and 40% ± 31% (P<.01) for AP-PA. CONCLUSIONS The use of IMRT and 4D treatment planning resulted in the delivery of a higher RT dose to the liver compared with the standard AP-PA technique. Whole-liver IMRT also delivered a significantly lower dose to the remaining kidney.
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Affiliation(s)
- John A Kalapurakal
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA.
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van Laarhoven S, van Baren R, Tamminga RYJ, de Jong KP. Radiofrequency ablation in the treatment of liver tumors in children. J Pediatr Surg 2012; 47:e7-e12. [PMID: 22424376 DOI: 10.1016/j.jpedsurg.2011.10.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/12/2011] [Accepted: 10/28/2011] [Indexed: 02/08/2023]
Abstract
Hepatoblastoma and liver metastasis of Wilms' tumors are rare hepatic tumors in children. Treatment of both tumors consists of a combination of chemotherapy and liver surgery. Radiofrequency ablation (RFA) is frequently used for the treatment of adult liver tumors but is rarely mentioned as a treatment option in pediatric liver tumors. We present a patient with hepatoblastoma and 1 with liver metastasis from a Wilms' tumor. Both patients were treated according to the latest protocols except that surgery included use of RFA. Both are well and recurrence free 8 and 3 years after surgery. Radiofrequency ablation may be a good addition to the existing arsenal of treatment modalities for pediatric liver tumors.
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Affiliation(s)
- Stijn van Laarhoven
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Department of Surgery, 9700 RB Groningen, The Netherlands.
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38
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Abstract
Wilms tumor is the most common renal malignancy that occurs in childhood. The remarkable evolution of treatment for this malignancy has served as a paradigm for multimodal cancer treatment. A rich database has accrued over time from well-controlled clinical trials. Translational research has directly affected patient care by allowing risk-based therapy. This article will summarize advances in our knowledge of the biology of Wilms tumor and describe the impact on clinical treatment of Wilms tumor.
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Affiliation(s)
- Thomas E Hamilton
- Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
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39
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Abstract
Significant improvement has been made in the treatment of children with Wilms tumor. New protocols are in place designed to maintain a high rate of cure for these patients while minimizing toxicity, based on refinement of the risk-stratification system.
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Affiliation(s)
- Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
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40
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Tumor biology influences the prognosis of nephroblastoma patients with primary pulmonary metastases: results from SIOP 93-01/GPOH and SIOP 2001/GPOH. Ann Surg 2011; 254:155-62. [PMID: 21670612 DOI: 10.1097/sla.0b013e318222015e] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To analyze the outcome of Wilms' tumor patients with primary lung metastases. SUMMARY BACKGROUND DATA Radiotherapy and/or surgery are used for local control of primary pulmonary Wilms' tumor metastases. A widely accepted treatment standardization is still lacking. METHODS Data for 210 patients with Wilms' tumor and primary lung metastases from the collaborative multicenter trials SIOP 93-01/GPOH and SIOP 2001/GPOH of the German Society of Pediatric Oncology and Hematology were reviewed. Analyses included patient data, tumor characteristics, local treatment, outcome and possible prognostic factors. RESULTS Five-year overall survival (OS) was 83.3% and 5-year event free survival (EFS) was 72.3% for all children. Survival was significantly poorer in children with high risk primary tumor histology (OS 44.4%) compared to low risk (OS 100.0%) and intermediate risk histology (OS 89.2%, P < 0.001). Within the high risk group, tumors of the blastemal subtype (OS 56.5%) were associated with a significantly better outcome than those presenting with diffuse anaplasia (OS 22.2%, P = 0.02). Further, prognostic markers were lacking response to chemotherapy (P = 0.011), persistence of metastases after local treatment (P = 0.007), and vitality of metastases (P = 0.01). CONCLUSIONS The prognosis of children with primary Wilms' tumor lung metastases mainly depends on the biology of primary tumors and metastases and is excellent with adequate treatment. Pulmonary metastasectomy is indicated if complete remission can be achieved to avoid lung irradiation. In the future a standardized local approach to nonresponding lung metastases (metastasectomy, irradiation, or both) will have to be prospectively evaluated regarding outcome, acute toxicity, and late effects.
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