title: Wilms' tumor: reduced-dose radiotherapy in advanced-stage Wilms' tumor with favorable histology.
abstract: Fifty-two children with favorable histology Wilms' tumor who had residual abdominal disease (Surgical Stages III and IV) were treated from 1979 to 1988 on a protocol designed to assess the effectiveness of reduced radiation doses. All patients received three-agent chemotherapy, beginning within 1 week after surgery. To permit assessment of disease response to initial chemotherapy, radiation therapy was delayed for a median of 28 days after surgery (range, 14-71 days). Total doses of abdominal radiation were limited to 12 Gy, given as 150 cGy daily fractions; 18 patients with Stage IV disease received 12 Gy bilateral pulmonary irradiation. Two year disease-free survival was 85% and 71% for Stage III and IV, respectively (p = .24). Abdominal relapses occurred in 3 cases (5.7%). The interval between surgery and initiation of irradiation was not related to disease-free survival. Of several patient and disease-related factors analyzed, only patient age was related to outcome. Disease-free survival was 100% at 3 years for children under the age of 3 versus 78% for children greater than age 3 (p = .05). Reduced-dose abdominal radiotherapy in conjunction with multi-agent chemotherapy and surgery provided excellent disease control with minimal toxicity in advanced-stage, favorable histology Wilms' tumor.
authors.affiliation: Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN.
authors.forename: R L
authors.initials: RL
authors.lastname: Tobin
authors.forename: J
authors.initials: J
authors.lastname: Fontanesi
authors.forename: L E
authors.initials: LE
authors.lastname: Kun
authors.forename: D L
authors.initials: DL
authors.lastname: Fairclough
authors.forename: H O
authors.initials: HO
authors.lastname: Hustu
authors.forename: W J
authors.initials: WJ
authors.lastname: Pao
authors.forename: E C
authors.initials: EC
authors.lastname: Douglass
authors.forename: J
authors.initials: J
authors.lastname: Wilimas
authors.forename: A P
authors.initials: AP
authors.lastname: Kumar
authors.forename: J J
authors.initials: JJ
authors.lastname: Jenkins
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000532:radiotherapy; D008297:Male; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D009396:Wilms Tumor / Q000188:drug therapy / Q000453:epidemiology* / Q000532:radiotherapy