title: Significance and management of computed tomography detected pulmonary nodules: a report from the National Wilms Tumor Study Group.
abstract: OBJECTIVE
  To define the optimal treatment for children with Wilms tumor who have pulmonary nodules identified on chest computed tomography (CT) scan, but have a negative chest radiograph, we evaluated the outcome of all such patients randomized or followed on National Wilms Tumor Study (NWTS)-3 and -4.
  
  
  METHODS
  We estimated the event-free and overall survival percentages of 53 patients with favorable histology tumors and pulmonary densities identified only by CT scan (CT-only) who were treated as Stage IV with intensive doxorubicin-containing chemotherapy and whole-lung irradiation, and compared these to the event-free and overall survival percentages of 37 CT-only patients who were treated less aggressively based on the extent of locoregional disease with 2 or 3 drugs, and without whole-lung irradiation.
  
  
  RESULTS
  The 4-year event-free and overall survival percentages of the 53 patients with CT-only nodules and favorable histology Wilms tumor who were treated as Stage IV were 89% and 91%, respectively. The 4-year event-free and overall survival percentages for the 37 patients with CT-only nodules and favorable histology who were treated according to the extent of locoregional disease were 80% and 85%, respectively. The differences observed between the 2 groups were not statistically significant. Among the patients who received whole-lung irradiation, there were fewer pulmonary relapses, but more deaths attributable to lung toxicity.
  
  
  CONCLUSIONS
  The current data raise the possibility that children with Wilms tumor and CT-only pulmonary nodules who receive whole lung irradiation have fewer pulmonary relapses, but a greater number of deaths due to treatment toxicity. The role of whole lung irradiation in the treatment of this group of patients cannot be definitively determined based on the present data. Prolonged follow-up of this group of patients is necessary to accurately estimate the frequency of late, treatment-related mortality.
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, CA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Meisel
authors.forename: K A
authors.initials: KA
authors.lastname: Guthrie
authors.forename: N E
authors.initials: NE
authors.lastname: Breslow
authors.forename: S S
authors.initials: SS
authors.lastname: Donaldson
authors.forename: D M
authors.initials: DM
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D015337:Multicenter Studies as Topic; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary*; D014057:Tomography, X-Ray Computed; D014750:Vincristine / Q000008:administration & dosage; D009396:Wilms Tumor / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary*
chemical_list: D003609:Dactinomycin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide