Renal failure does not preclude cure in children receiving chemotherapy for Wilms tumor: a report from the National Wilms Tumor Study Group.
BACKGROUND
Children with Wilms tumor can develop renal failure during treatment. Since there are few published data concerning the appropriate chemotherapy for this situation, we reviewed the experience of children who developed renal failure while being treated on National Wilms Tumor Study Group (NWTSG) studies 1-4 (1969-1994).


METHODS
Data files in the NWTSG Data Center for all patients with Wilms tumor were screened. Patient demographics and tumor and treatment data were abstracted from those who developed renal failure.


RESULTS
Twenty-eight of 5,910 (0.47%) children with Wilms tumor registered on NWTSG studies I through IV (1971-1994) were treated with chemotherapy after developing renal failure. Among these patients vincristine at full dose (0.05 mg/kg dose) did not increase the risk of severe toxicity. Dactinomycin (full dose: 15 mcg/kg day x 5) increased the risk for severe neutropenia when given at 75-100% of full dose. There was no compelling evidence for increased toxicity of doxorubicin when given at 100% versus 50% dosing (full dose: 20 mg/m(2) day x 3), but the number of patients analyzed was small. The overall survival percentage was 39%, but 64% for those patients who were in their initial treatment phase at the time of renal failure.


CONCLUSIONS
The data suggest that, in the setting of renal failure, reduction of dosing is not necessary for the three main agents used for treatment of newly diagnosed Wilms tumor, and cure is not precluded. Accurate pharmacologic and pharmacokinetic studies are needed for any patient being treated while in renal failure.
Feusner
James H
JH
Department of Hematology/Oncology, Children's Hospital & Research Center Oakland, Oakland, California, USA. jfeusner@mail.cho.org
Ritchey
Michael L
ML
Norkool
Pat A
PA
Takashima
Janice R
JR
Breslow
Norman E
NE
Green
Daniel M
DM
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003609:Dactinomycin / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D007223:Infant; D007680:Kidney Neoplasms / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D051437:Renal Insufficiency / Q000150:complications* / Q000209:etiology; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D009396:Wilms Tumor / Q000150:complications* / Q000188:drug therapy*
D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide