Treatment of Wilms tumor relapsing after initial treatment with vincristine, actinomycin D, and doxorubicin. A report from the national Wilms tumor study group

Marcio Malogolowkin, Cecilia A. Cotton, Daniel M. Green, Norman E. Breslow, Elizabeth Perlman, James Miser, Michael L. Ritchey, Patrick R.M. Thomas, Paul E. Grundy, Giulio J. D'Angio, J. Bruce Beckwith, Robert C. Shamberger, Gerald M. Haase, Milton Donaldson, Robert Weetman, Max J. Coppes, Patricia Shearer, Peter Coccia, Morris Kletzel, Roger MacklisGail Tomlinson, Vicki Huff, Robert Newbury, Douglas Weeks

Research output: Contribution to journalArticlepeer-review

101 Scopus citations

Abstract

Objective. We evaluated the use of alternating cycles of cyclophosphamide/etoposide and carboplatin/etoposide in children entered on National Wilms Tumor Study (NWTS)-5 who were diagnosed between August 1, 1995 and May 31, 2002 and who relapsed after chemotherapy with vincristine, actinomycin D, and doxorubicin (VAD) and radiation therapy (DD-4A). Patients And Methods. One hundred three patients who relapsed or had progressive disease after initial VAD chemotherapy and radiation therapy were registered on stratum C of the NWTS-5 Relapse protocol. Twelve patients were not evaluable: five due to insufficient data, six due to major protocol violations, and one for refusal of therapy. Among the 91 remaining patients, 14 with stage V Wilms tumor (WT), 1 with contralateral relapse, and 16 who did not achieve a complete response (CR) to the initial three-drug chemotherapy were not included in this analysis. Relapse treatment included alternating courses of the drug pairs cyclophosphamide/etoposide and carboplatin/etoposide, surgery, and radiation therapy. Results. The outcomes of 60 patients were analyzed. The lung was the only site of relapse for 33 patients; other sites of relapse included the operative bed, the abdomen, and liver. Four-year event-free survival (EFS) and overall survival (OS) were 42.3 and 48.0% respectively for all patients and were 48.9 and 52.8% for those who relapsed in the lungs only. Thrombocytopenia was the most frequent toxicity. Conclusion. These results demonstrate that approximately one-half of children with unilateral WT who relapse after initial treatment with VAD and radiation therapy can be successfully retreated.

Original languageEnglish (US)
Pages (from-to)236-241
Number of pages6
JournalPediatric Blood and Cancer
Volume50
Issue number2
DOIs
StatePublished - Feb 2008

Keywords

  • Chemotherapy
  • Phase II clinical trials
  • Radiation oncology
  • Solid tumors
  • Wilms tumor (WT)

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

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