Outcomes in low-risk babies treated with half-dose chemotherapy according to the Third National Wilms' Tumor Study.

1992 ◽  
Vol 10 (8) ◽  
pp. 1305-1309 ◽  
Author(s):  
B W Corn ◽  
J W Goldwein ◽  
I Evans ◽  
G J D'Angio
Keyword(s):  
Wilms Tumor ◽  
Survival Rates ◽  
Chemotherapeutic Agents ◽  
Low Risk ◽  
Hematologic Toxicity ◽  
Older Children ◽  
The Third ◽  
Favorable Histology ◽  
Tumor Study ◽  
Half Dose

PURPOSE To determine whether the 50% dose reduction of all chemotherapeutic agents recommended for babies (less than or equal to 12 months of age) by the Third National Wilms' Tumor Study (NWTS-3) produced acceptable toxicity without sacrificing any survival benefit. MATERIALS AND METHODS The 365 babies enrolled in NWTS-3 had tumors of varying histologies and stages. The present analysis was restricted to the 256 infants who had tumors of favorable histology, were free of metastasis at diagnosis, and received treatment according to NWTS-3 guidelines. RESULTS Despite the recommended attenuation of drug doses observed in 75% of the chemotherapy courses received, outcomes for these babies were comparable to those obtained in older children given full doses of chemotherapy. Four-year survival rates for 256 babies with stages I (n = 199), II (n = 38), and III (n = 19) favorable-histology tumors were 96%, 95%, and 90%, respectively. The figures for 498 stage I, 342 stage II, and 373 stage III older children with favorable-histology lesions were 92%, 94%, and 91% in that order. There were no deaths from hematologic toxicity or infection among babies who received half-dose chemotherapy. The death rates for their older NWTS-3 counterparts was 1%. CONCLUSION Less aggressive therapies advocated for babies in NWTS-3 provide acceptable levels of morbidity without compromising the excellent results previously reported for low-risk patients of all ages.

Prognostic factors for children with recurrent Wilms' tumor: results from the Second and Third National Wilms' Tumor Study.

1989 ◽  
Vol 7 (5) ◽  
pp. 638-647 ◽  
Author(s):  
P Grundy ◽  
N Breslow ◽  
D M Green ◽  
K Sharples ◽  
A Evans ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Wilms Tumor ◽  
Survival Rates ◽  
Initial Therapy ◽  
Chemotherapeutic Agents ◽  
Stage I ◽  
Prognostic Features ◽  
Favorable Histology ◽  
Tumor Study ◽  
Unilateral Disease

The characteristics of 367 stage I-IV National Wilms' Tumor Study (NWTS) children who relapsed after initial treatment for unilateral disease in the second and third NWTS trials (NWTS-2 and -3) were analyzed to identify features predictive of survival. Although modifications in initial therapy resulted in a lower rate of first relapse in these two studies compared with NWTS-1, all previously identified prognostic factors after relapse remained statistically significant predictors of survival. Tumor histology, length of initial remission, initial therapy with two v three drugs, and site of relapse each were independently predictive of postrelapse survival. The 3-year postrelapse survival for all 367 patients was 30% +/- 3%; however, subgroups classified by these prognostic factors were identified that had 3-year postrelapse survival rates of greater than 40%. These subgroups included patients who had tumors of favorable histology (FH) that recurred (1) only in the lungs, (2) in the abdomen when radiotherapy (RT) was not initially given, or (3) that were originally stage I, (4) that were originally treated with only two drugs, or (5) that recurred 12 months or more after diagnosis. These results were achieved with the use of standard treatments, ie, surgery, RT, and chemotherapy using dactinomycin (AMD), vincristine (VCR), and Adriamycin [( ADR] doxorubicin; Adria Laboratories, Columbus, OH). It is suggested that patients in these groups might be managed with aggressive use of conventional therapies until newer chemotherapeutic agents and drug combinations are shown to be more effective. Patients with adverse prognostic features at relapse have a poor survival expectancy with standard measures. Salvage attempts for these patients are better based on experimental approaches.

scholarly journals Prognostic factors in nonmetastatic, favorable histology wilms' tumor. Results of the third national wilms' tumor study

Cancer ◽  
1991 ◽  
Vol 68 (11) ◽  
pp. 2345-2353 ◽  
Author(s):  
Norman Breslow ◽  
Katrina Sharples ◽  
J. Bruce Beckwith ◽  
Janice Takashima ◽  
Panayotis P. Kelalis ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Wilms Tumor ◽  
The Third ◽  
Favorable Histology ◽  
Tumor Study

Comparison between single-dose and divided-dose administration of dactinomycin and doxorubicin for patients with Wilms' tumor: a report from the National Wilms' Tumor Study Group.

1998 ◽  
Vol 16 (1) ◽  
pp. 237-245 ◽  
Author(s):  
D M Green ◽  
N E Breslow ◽  
J B Beckwith ◽  
J Z Finklestein ◽  
P E Grundy ◽  
...  
Keyword(s):  
Single Dose ◽  
Divided Dose ◽  
Clear Cell ◽  
Wilms Tumor ◽  
Dose Intensity ◽  
Clear Cell Sarcoma ◽  
Hematologic Toxicity ◽  
Cell Sarcoma ◽  
Favorable Histology ◽  
Tumor Study

PURPOSE The National Wilms' Tumor Study (NWTS)-4 was designed to evaluate the efficacy, toxicity, and cost of administration of different regimens for the treatment of Wilms' tumor (WT). PATIENTS AND METHODS Between August 6, 1986 and September 1, 1994, 1,687 previously untreated children less than 16 years of age with stages I to II/favorable histology (FH) or stage I/anaplastic histology WT (low-risk [LR] group) or stages III to IV/FH WT or stages I to IV/clear cell sarcoma of the kidney (high-risk [HR] group) were randomized to treatment that included vincristine and either divided-dose (standard [STD]) courses (5 days) or single-dose (pulse-intensive [PI]) treatment with dactinomycin. HR patients also received either STD courses (3 days) or PI treatment with doxorubicin. RESULTS The 2-year relapse-free survival (RFS) rates for LR patients were 91.3% for 544 randomized to treatment with PI and 91.4% for 556 randomized to treatment with STD chemotherapy (P = .988). The 2-year RFS rates for HR patients were 87.3% for 299 randomized to treatment with PI and 90.0% for 288 randomized to treatment with STD chemotherapy (P = .865). CONCLUSION We conclude that patients treated with PI combination chemotherapy for LR or HR WT or clear cell sarcoma of the kidney have equivalent 2-year RFS to those treated with STD regimens. PI drug administration is recommended as the new standard based on demonstrated efficacy, greater administered dose-intensity, less severe hematologic toxicity, and the requirement for fewer physician and hospital encounters.

Toxic deaths in the Second National Wilms' Tumor Study.

1984 ◽  
Vol 2 (9) ◽  
pp. 1028-1033 ◽  
Author(s):  
B Jones ◽  
N E Breslow ◽  
J Takashima
Keyword(s):  
Renal Failure ◽  
Wilms Tumor ◽  
Chemotherapeutic Agents ◽  
Drug Induced ◽  
Tumor Study ◽  
Group I ◽  
Half Dose ◽  
The Difference ◽  
One Year ◽  
Radiation Pneumonopathy

There were 122 deaths among 803 children registered, randomized, and followed in the second National Wilms' Tumor Study; 17 occurred in children apparently free of disease and were attributable to causes other than tumor progression. Seven deaths were attributed to infection during periods of drug-induced leukopenia; four were due to liver failure; and one each was attributable to radiation pneumonopathy, intestinal obstruction, renal failure, myocardial disease, and encephalopathy. The cause of one death was unexplained. Of particular concern were four (of 47) infants under one year of age with group I or II disease who had toxic deaths. Subsequent to these experiences the doses of all chemotherapeutic agents were reduced by 50% for infants under one year of age. No deaths from toxicity were observed thereafter in infants. An analysis of the therapeutic effect of this dose reduction showed three of 47 relapsed on full dose and five of 54 on half dose. The difference is not statistically significant. This report is a further demonstration of the potentially serious vulnerability of infants to standard doses of anticancer drugs even when they are calculated on a per kilogram basis.

scholarly journals Treatment of Wilms' tumor. Results of the third national Wilms' tumor study

Cancer ◽  
1989 ◽  
Vol 64 (2) ◽  
pp. 349-360 ◽  
Author(s):  
Giulio J. D'angio ◽  
Norman Breslow ◽  
J. Bruce Beckwith ◽  
Audrey Evans ◽  
Edward Baum ◽  
...  
Keyword(s):  
Wilms Tumor ◽  
The Third ◽  
Tumor Study

Bilateral Wilms' tumor: long-term survival and some epidemiological features.

1989 ◽  
Vol 7 (3) ◽  
pp. 310-315 ◽  
Author(s):  
M J Coppes ◽  
J de Kraker ◽  
P J van Dijken ◽  
H J Perry ◽  
J F Delemarre ◽  
...  
Keyword(s):  
Wilms Tumor ◽  
Survival Rates ◽  
Tumor Stage ◽  
Advanced Tumor Stage ◽  
Older Children ◽  
Term Survival ◽  
Contralateral Kidney ◽  
Advanced Tumor ◽  
Bilateral Wilms Tumor

Sixty-seven children with a bilateral Wilms' tumor (BWT) who were registered to the International Society of Pediatric Oncology (SIOP) nephroblastoma trial and studies 1, 2, and 5, conducted between 1971 and 1980, were analyzed. The overall 10-year survival was 64%. While most deaths due to tumor occurred within 3 years after diagnosis of bilateral disease, five patients died after 3 years (20%), three with synchronous and two with metachronous BWT. The survival rates for the 42 children with synchronous BWT (follow-up time, 6 1/2 to 14 years) and the 25 children with metachronous BWT (follow-up time, 5 to 13 years) were 69% and 56%, respectively. Due to an improvement in the synchronous group, overall survival improved over the years: 47%, 72%, and 70%, in SIOP 1, 2, and 5, respectively. Age at diagnosis and most advanced tumor stage affected prognosis. Children presenting a tumor manifestation before the age of 2 years had better prognosis than older children. This difference is significant in synchronous BWT. Prognosis for children with local stage 1 or 2 was better than for those with local stage 3. Median age at initial presentation in BWT was lower than in unilateral nephroblastoma and lower in metachronous BWT than in synchronous BWT. Young children presenting with unilateral nephroblastoma should have a careful follow-up of the contralateral kidney for at least the next 3 1/2 years, as most contralateral tumors will develop during this period.

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