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Pediatr Blood Cancer. 2018 Aug;65(8):e27085. doi: 10.1002/pbc.27085. Epub 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.

Author information

1
Department of Radiation Oncology, University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
2
Radiation Oncology Department, Leuven Cancer Center, Leuven, Belgium.
3
Department of Radio-Oncology, University Hospital of Saarland, Homburg, Germany.
4
Department of Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
5
Cancer Section, University College London Institute of Child Health, London, UK.
6
Department of Paediatric Oncology, Centre Leon Berard, Lyon, France.
7
Department of Paediatric Oncology, University Hospital of Saarland, Homburg, Germany.
8
Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands.
9
Department of Radiation Oncology. The Christie NHS Foundation Trust, The Christie NHS Foundation Trust, Manchester, UK.
10
Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands.

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.

KEYWORDS:

Wilms tumour; boost; intermediate risk; lymph node; radiotherapy

PMID:
29693799
DOI:
10.1002/pbc.27085
[Indexed for MEDLINE]

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