期刊
EUROPEAN JOURNAL OF CANCER
卷 163, 期 -, 页码 88-97出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.ejca.2021.12.014
关键词
Wilms tumour; Recurrence; SIOP protocol; Treatment outcome
类别
资金
- Deutsche Krebshilfe [70-1899, 50-2709Gr2]
- Nederlandse Stichting Kindergeneeskundig Kankeronderzoek [86e04]
- Cancer Research UK [C1188/A8687]
- UK National Cancer Research Network
- Barncancerfonden in Sweden
- Children's Cancer and Leukaemia Group (CCLG)
- Socie' te' Francaise des Cancers de l'Enfant
- Association Leon Berard Enfant Cancereux
- Enfant et Sant
- Gesellschaft fur Padiatrische Onkologie und Hamatologie
- Grupo Cooperativo Brasileiro para o Tratamento do Tumor de Wilms
- Sociedade Brasileira de Oncologia Pediatrica
- Spanish Society of Pediatric Hematology and Oncology
- Spanish Association Against Cancer
- SIOP-NL
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre
This study retrospectively evaluated the rescue treatment and survival of patients with relapsed Wilms tumor (WT) after receiving vincristine and actinomycin-D treatment. The results showed that there was no significant difference in event-free survival and overall survival between patients treated with VAD regimens and those treated with more intensive regimens.
Purpose: Society of International Pediatric Oncology - Renal Tumor Study Group (SIOP-RTSG) treatment recommendations for relapsed Wilms tumour (WT) are stratified by the intensity of first-line treatment. To explore the evidence for the treatment of patients relapsing after vincristine and actinomycin-D (VA) treatment for primary WT, we retrospectively evaluated rescue treatment and survival of this patient group. Patients and methods: We included 109 patients with relapse after VA therapy (no radiotherapy) for stage I-II primary low-or intermediate-risk WT from the SIOP 93-01 and SIOP 2001 studies. Univariate Cox regression analysis was performed to study the effect of relapse treatment intensity on event-free survival (EFS) and overall survival (OS). Relapse treatment intensity was classified into vincristine, actinomycin-D, and either doxorubicin or epirubicin (VAD), and more intensive therapies (ifosfamide/carboplatin/etoposide [ICE]/> 4 drugs/ high-dose chemotherapy with haematopoietic stem cell transplantation [HD HSCT]). Results: Relapse treatment regimens included either VAD, or cyclophosphamide/carboplatin/ etoposide/doxorubicin (CyCED), or ICE backbones. Radiotherapy was administered in 62 patients and HD HSCT in 15 patients. Overall, 5-year EFS and OS after relapse were 72.3% (95% confidence interval [CI]: 64.0-81.6%) and 79.3% (95% CI: 71.5-88.0%), respectively. Patients treated with VAD did not fare worse when compared with patients treated with more intensive therapies (hazard ratio EFS: 0.611 [95% CI: 0.228-1.638] [p-value = 0.327] and hazard ratio OS: 0.438 [95% CI: 0.126-1.700] [p-value = 0.193]). Conclusion: Patients with relapsed WT after initial VA-only treatment showed no inferior EFS and OS when treated with VAD regimens compared with more intensive rescue regimens. A subset of patients relapsing after VA may benefit from less intensive rescue treatment than ICE/CyCED-based regimens and deserve to be pinpointed by identifying additional (molecular) prognostic factors in future studies. (C) 2021 The Authors. Published by Elsevier Ltd.
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