Adjuvant therapy

The use of chemotherapy and radiotherapy as adjuvants to surgery is now an essential part of WT treatment. Major advances in treatment have come as a result of multicentre co-operative trials run by the US National Wilms' Tumour Study (NWTS) Group, the International Society of Paediatric Oncology (SIOP), and the UK Children's Cancer

Table 22.2 Main findings in NWTS 1, 2, and 3

NWTS 1

Group I

Patients under two years of age do not all need

radiotherapy.

Group II/III

AMD plus VCR is better than either alone.

Group IV

Pre-operative vincristine is of no benefit.

Other findings

Unfavourable histology and lymph-node

involvement are adverse features.

NWTS 2

Stage I

No patients benefit from radiotherapy regardless

of age.

6 months of VCR and AMD is as good as

15 months.

Stages II, III, and IV

Addition of doxo to VCR and AMD improves

survival.

Other findings

Stages II and III have the same survival. Local

spillage and invasion of the renal vein do not affect

outcome.

NWTS 3

Stage I

10 weeks therapy with VCR/AMD is as effective

as 6 months.

Stage II

Intensive VCR/AMD is as effective as three drugs.

Addition of radiotherapy does not affect survival.

Stage III

Intensive VCR/AMD is as effective as three drugs.

10 Gy flank irradiation is as effective as 20 Gy.

Other findings

Addition of cyclophosphamide to VCR/AMD/doxo

does not improve survival.

Key: VCR = vincristine; AMD = actinomycin D; doxo = doxorubicin

Table 22.3

Outcome for patients in NWTS III

Stage

2-year relapse-free survival (%)

2-year overall survival (%)

Treatment

I

92

97

10 weeks vincristine + actinomycin D

II/III

87

91

15 months vincristine + actinomycin D + doxorubicin

III

78

86

10 Gy + vincristine + actinomycin D +/- doxorubicin

IV + UH

72

81

UH = Unfavourable histology

Table 22.4 Outcome for patients in UKW1

Stage

3-yr eventfree survival (%)

3-yr overall survival

(%)

6-yr event- 6-yr overall free survival survival (%) (%)

I

90

96

89 96

II

85

94

85 93

III

82

83

IV 58 65 50 65

Study Group (UKCCSG). An essential part of all therapy protocols is the 'stage' of the tumour. The NWTS staging system is:

Tumour within renal capsule and fully resected. Tumour outside renal capsule but fully resected; biopsy; ruptured; confined to the flank.

Tumour outside capsule and incompletely resected; lymph-node involvement at the hilum or paraortic chain.

Stage IV

Haematogenous metastases e.g. to lungs, liver, bone, or brain.

Bilateral renal tumours.

0 0

Post a comment