This fundamental paper by a surgeon, Dr Gross, and a radiologist and radiotherapist, Dr Neuhauser, cleaned up the existing information and conflicting results of therapy for Wilms' tumor through 1947. There is a careful review of literature, comments about existing suggestions of preoperative radiation versus postoperative radiation versus radiation only and versus surgery without radiation. The authors then carefully analyze the experience at Boston Children's Hospital over the period from 1914 to 1947. This material is carefully broken down into three periods, 1914 to 1930, 1931 to 1939, and 1940 to 1947. During period I, 1914 to 1930, 27 cases of Wilms' tumor were seen and four cures were obtained for a survival rate of 14.9%. Beginning in 1931, under the able leadership of Dr William E. Ladd, a vigorous approach to the surgery for children with Wilms' tumor was undertaken. The program consisted of a wide transabdominal incision rather than the more classic approach to kidney surgery by a flank incision. This surgical exposure allowed prompt identification and control of the renal vessels and removal, in most cases, of the entire tumor and kidney mass without rupture of the encapsulated tumor. Additionally, Dr. Ladd insisted on careful fluid and blood replacement before and during surgery and a meticulous approach to the anesthestic management of the child undergoing surgery. In previous experience at Boston Children's and other reported centers, there had been a large number of intraoperative deaths. After 1932, there were no deaths from the surgery at Children's Hospital in Boston. In the 1931 to 1939 experience, 31 patients were operated on and ten cures were achieved for a survival rate of 32.2%.
Beginning in 1940, Dr Gross and Dr Neuhauser instituted a program of immediate surgery and postoperative radiation to the bed of the tumor. Thirty-eight children were so treated with a survival rate of 47.3%. This group of patients was subsequently followed for 2½ years so that cures, recurrences, and deaths could be accurately reported. This patient material also emphasized that babies in the first 12 months of life had a far better outlook than did older subjects. The authors also emphasized that if recurrences were to occur, they were usually evident within 9 months after operative removal and radiation therapy. Postoperative radiation therapy was given in daily doses of 200r alternately using three portals, anteriorly, laterally, and posteriorly over the tumor bed reaching a total of 4000 to 5000r using a 200KV machine.
Reappraisal of the role of postoperative radiation therapy in patients with pIIIa-N2 non-small cell lung cancer: A propensity score matching analysis
