Pediatr Blood Cancer 2018 Apr 25
Evaluation of boost irradiation in patients with intermediate-risk stage III Wilms tumour with positive lymph nodes only: Results from the SIOP-WT-2001 Registry.
Abstract
Objective
To evaluate the value of radiotherapy boost omission in patients with intermediate-risk, stage III Wilms tumours (WT) with positive lymph nodes (LN).
Methods and materials
All patients with intermediate-risk, stage III (LN positive) WT consecutively registered in the SIOP-WT-2001 study were included in this analysis. Endpoints were 5-year event-free survival (EFS), loco-regional control (LRC) and overall survival (OS).
Results
Between June 2001 and May 2015, 2,569 patients with stage I to III WT after preoperative chemotherapy were registered in the SIOP-WT-2001 study. Five hundred and twenty-three (20%) had stage III disease, of which 113 patients had stage III due to positive LN only. Of those, 101 (89%) received radiotherapy, 36 of which (36%) received, apart from flank irradiation, a boost dose to the LN positive area. Four patients (4%) did not receive any adjuvant radiotherapy. In eight patients information on radiotherapy was not available. With a median follow-up of 71 months, no difference in 5-year EFS (84% vs. 83%, P = 0.77) and LRC (96% vs. 97%, P = 0.91) was observed between patients receiving a radiotherapy boost and those without boost, respectively. Five-year OS, including salvage therapy, was excellent (boost vs. no boost: 97% vs. 95%, P = 0.58).
Conclusions
Outcome data demonstrate that omission of the radiotherapy boost to the loco-regional positive lymph nodes in patients with intermediate-risk, stage III WT who receive preoperative chemotherapy and postoperative flank irradiation (14.4 Gy) can be considered a safe approach for future SIOP protocols.
Related Questions
Would you give whole-abdomen RT for preoperative rupture of favorable histology Wilm's Tumor treated with induction chemotherapy followed by GTR?
The short answer is yes, if you saw free fluid in the pelvis pre-treatment, and there were other signs of pre-operative rupture at the time of resection following chemotherapy, then WART should be considered.Given that the patient had positive LN at diagnosis, I would review the path report to see i...
What is the radiation volume for unresected gross paraaortic lymph node in a Wilms patient?
This depends on the presence/absence of diffuse anaplasia (See AREN0321 [NCT00335556]) and age/field extent.Patients with diffuse anaplasia who are Stage 3 due to the presence of residual nodal disease would receive 19.8 Gy to the flank, and then in the presence of residual disease, would receive a ...