Treatment outcomes in patients less than 2 years of age with small, stage I, favorable-histology Wilms' tumors: a report from the National Wilms' Tumor Study.
OBJECTIVE
Retrospective analyses were performed to determine the effect of tumor weight and therapy modifications on outcome in patients less than 2 years of age with stage I favorable-histology Wilms' tumors.


METHODS
The 4-year relapse-free and overall survival percentages for patients randomized to different treatment regimens in National Wilms' Tumor Studies (NWTS)-1, -2, and -3 were calculated and compared.


RESULTS
The 4-year relapse-free survival percentages of patients whose specimen weight was less than 550 g were found to be 89.1% on NWTS-1, 96.0% on NWTS-2, and 93.2% on NWTS-3. There was no evidence that the relapse-free survival of these patients had improved over time (P value for trend = .99). The 4-year relapse-free survival percentage for similar age and stage patients whose specimen weight was 550 g or greater was significantly poorer than that of patients with smaller tumors (P = .02).


CONCLUSIONS
Changes in the NWTS treatment regimens over a period of more than 20 years have not improved on the excellent prognosis of patients who are less than 2 years of age at diagnosis and who have a stage I, favorable-histology Wilms' tumor with specimen weight less than 550 g. These data could be used as the basis for a future trial in which a subgroup of such patients is treated with nephrectomy only.
Department of Pediatrics, Roswell Park Cancer Institute, Buffalo, NY 14263-0001.
D M
DM
Green
N E
NE
Breslow
J B
JB
Beckwith
J
J
Takashima
P
P
Kelalis
G J
GJ
D'Angio
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D009392:Nephrectomy; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000473:pathology / Q000628:therapy*
D003609:Dactinomycin