Whole-Lung Irradiation for Stage IV Wilms Tumor Patients: Thyroid Dosimetry and Outcomes

Data from patients with pulmonary metastases (PM) from Wilms' tumor at diagnosis (stage IV) were collected from six European centers. All patients were pretreated with a chemotherapy (CT) regimen consisting of vincristine (VCR), dactinomycin (AD), and Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH). After nephrectomy, local therapy for residual pulmonary disease was considered to avoid whole-lung irradiation. Only four of 36 patients still had multiple inoperable metastases after preoperative CT. Thirty patients survived. Four of them were irradiated. Of the six patients who died, four died of PM, one died of abdominal recurrence, and one of therapy-related disease. Disease-free survival and actuarial survival rates are 83% with a mean follow-up of 4 years postnephrectomy.

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Results of the United Kingdom Children's Cancer Study Group first Wilms' Tumor Study.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.1.124 ◽

1995 ◽

Vol 13 (1) ◽

pp. 124-133 ◽

Cited By ~ 96

Author(s):

J Pritchard ◽

J Imeson ◽

J Barnes ◽

S Cotterill ◽

D Gough ◽

...

Keyword(s):

United Kingdom ◽

Wilms Tumor ◽

Stage Iv ◽

Stage I ◽

Stage Ii ◽

Stage Iii ◽

Study Group ◽

Tumor Study ◽

Cancer Study Group ◽

Lung Irradiation

PURPOSE The first United Kingdom Children's Cancer Study Group (UKCCSG) Wilms' Tumor Trial (UKW1) applied treatment regimens stratified by stage and histology in accordance with National Wilms' Tumor Study (NWTS) criteria, seeking to reduce treatment of low-stage, favorable-histology (FH) tumors without impairing survival and to improve prognosis of stage III and IV (FH) and unfavorable-histology (UH) tumors with more intensive chemotherapy. PATIENTS AND METHODS Three hundred eighty-four consecutively diagnosed patients with Wilms' tumor were recruited from the 20 UKCCSG centers and Oslo, Norway, between January 1980 and June 1986. The regimen for stage I patients was vincristine (Vcr) only, while stage II patients received Vcr and dactinomycin (Act-D). Stage III patients received three-drug therapy and stage IV and UH patients four-drug regimens. Act-D was given as pulsed doses of 1.5 mg/m2 every 3 or every 6 weeks. No lung irradiation was used in stage IV patients. No randomized comparisons were attempted. End points were survival and event-free survival (EFS). RESULTS Survival at 6 years in FH patients was 96% for stage I, 93% for stage II, 83% for stage III, 65% for stage IV, and 50% for UH patients of all stages. CONCLUSION Vcr alone is as effective for stage I FH tumors as the two-drug regimen used in the NWTS and International Society of Pediatric Oncology (SIOP) studies. Fractionation of Act-D is unnecessary. The poorer results for stage IV FH and UH patients compared with the NWTS may be due to treatment differences, such as the use of lung irradiation for stage IV FH patients in NWTS3, and/or to case selection bias.

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Long-term follow-up of patients treated with whole lung irradiation for wilms' tumor metastatic to the lung

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/0360-3016(90)90753-7 ◽

1990 ◽

Vol 19 ◽

pp. 178

Author(s):

Roger Macklis ◽

A. Oltikar ◽

E. Larsen ◽

S. Sallan

Keyword(s):

Wilms Tumor ◽

Long Term Follow Up ◽

Lung Irradiation ◽

Whole Lung Irradiation

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The treatment of Wilms' tumor patients with pulmonary metastases detected only with computed tomography: a report from the National Wilms' Tumor Study.

Journal of Clinical Oncology ◽

10.1200/jco.1991.9.10.1776 ◽

1991 ◽

Vol 9 (10) ◽

pp. 1776-1781 ◽

Cited By ~ 46

Author(s):

D M Green ◽

D J Fernbach ◽

P Norkool ◽

G Kollia ◽

G J D'Angio

Keyword(s):

Overall Survival ◽

Ct Scan ◽

Pulmonary Metastases ◽

Wilms Tumor ◽

Favorable Histology ◽

Tumor Study ◽

Plain Chest Radiograph ◽

Number Of Patients ◽

Lung Irradiation ◽

Whole Lung Irradiation

To evaluate the prognosis of patients with Wilms' tumor who have pulmonary densities identified on a computed tomographic (CT) scan of the chest, but have a negative plain chest radiograph, we reviewed the treatments and outcome of 32 patients randomized or followed on National Wilms' Tumor Study (NWTS)-3. The 4-year event-free and overall survival percentages of 18 of these patients who had a favorable histology tumor and were treated as stage IV tumors with three or four drugs plus whole-lung irradiation were 88.1% and 94.0%, respectively. The 4-year event-free and overall survival percentages for nine favorable histology patients treated less aggressively based on the extent of locoregional disease with two or three drugs and without whole-lung irradiation were 88.9% and 88.0%, respectively. There were no statistically significant differences in the 4-year event-free or overall survival percentages between the two groups. The current data do not demonstrate improved survival for favorable histology patients treated with whole-lung irradiation for pulmonary metastases identified only on chest CT scan. However, due to the small number of patients included, no statistically valid conclusions regarding the roles of Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) and/or whole-lung irradiation in the treatment of these patients can be drawn from the present analysis. Additional patients need to be systematically studied to determine if these preliminary observations can be confirmed.

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Totally implantable catheter embolism: two related cases

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000600011 ◽

2008 ◽

Vol 126 (6) ◽

pp. 347-349 ◽

Cited By ~ 3

Author(s):

Rodrigo Chaves Ribeiro ◽

Áurea Cristina Ferreira Monteiro ◽

Quirino Cavalcante Menezes ◽

Sérgio Tomaz Schettini ◽

Sonia Maria Rossi Vianna

Keyword(s):

Wilms Tumor ◽

Rare Complication ◽

Case Series ◽

Stage Iv ◽

Venous Access ◽

Endovascular Procedure ◽

Asymptomatic Patients ◽

Case Series Study ◽

Series Study

CONTEXT AND OBJECTIVE: Long-term totally implantable catheters (e.g. Port-a-Cath®) are frequently used for long-term venous access in children with cancer. The use of this type of catheter is associated with complications such as infection, extrusion, extravasation and thrombosis. Embolism of catheter fragments is a rare complication, but has potential for morbidity. The aim here was to report on two cases in which embolism of fragments of a long-term totally implantable catheter occurred. DESIGN AND SETTING: Case series study at Hospital do Servidor Público Estadual, São Paulo. METHODS: Retrospective review of catheter embolism in oncological pediatric patients with long-term totally implantable catheters. RESULTS: The first patient was a 3-year-old girl diagnosed with stage IV Wilms' tumor. Treatment was started with the introduction of a totally implantable catheter through the subclavian vein. At the time of removal, it was realized that the catheter had fractured inside the heart. An endovascular procedure was necessary to remove the fragment. The second case was a boy diagnosed with stage II Wilms' tumor at the age of two years. At the time of removal, it was noticed that the catheter had disconnected from the reservoir and an endovascular procedure was also necessary to remove the embolized catheter. CONCLUSION: Embolism of fragments of totally implantable catheters is a rare complication that needs to be recognized even in asymptomatic patients.

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Clinicopathological Profile of Wilms Tumour in Children

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v32i1.21015 ◽

2014 ◽

Vol 32 (1) ◽

pp. 5-8

Author(s):

M Mazumder ◽

A Islam ◽

N Farooq ◽

M Zaman

Keyword(s):

Wilms Tumor ◽

Stage Iv ◽

Abdominal Distension ◽

Stage Ii ◽

Stage Iii ◽

Wilms Tumour ◽

Female Ratio ◽

Male Female Ratio ◽

Clinicopathological Profile ◽

Treatment Objective

Introduction: Wilms tumor is the most common primary malignant renal tumor of childhood. It is important to pick up the children with wilms tumor earlier as early stages has excellent outcomes after treatment. Objective : To find out the common clinical presentations and pathological profile of Wilms tumor in children. Methods and Materials : A hospital based prospective study done with twenty diagnosed patients of Wilms tumour enrolled from department of Pediatric haemato-oncology, BSMMU, Dhaka in the period between January to December 2008. Results- The peak incidence of Wilms tumor was in 1 to 5 years age group (80%,n=16). Median age at presentation was 49 months with male: female ratio 1.8:1.The most common presentation was abdominal swelling (80%,n=16),followed by flank mass (75%,n=15), abdominal pain (55%,n=11), haematuria (15%,n=3), hypertension (10%,n=2). Thirteen raised from right kidney, ratio of right to left involvement 1.8:1. Histologically 13(65%) patients had triphasic histology having blastemal, stromal and epithelial elements, 7(35%) was biphasic having blastema and epithelia. All had favourable histological pattern. Most patients presented in stage III (55%,n=11) followed by stage II (25%,n=5), Stage IV(10%,n=2), Stage I(10%,n=2). No bilateral presentation. Conclusions : Most of the patients of Wilms tumor presented within 1 to 5 years of age(80%) with abdominal distension(80%) and flank mass(75%), few associated with haematuria(15%) and hypertension(10%). Histologically all were favourable and maximum presented in stage III (55%) followed by stage II(25%). DOI: http://dx.doi.org/10.3329/jbcps.v32i1.21015 J Bangladesh Coll Phys Surg 2014; 32: 5-8

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