title: Treatment of Wilms tumor relapsing after initial treatment with vincristine, actinomycin D, and doxorubicin. A report from the National Wilms Tumor Study Group.
abstract: OBJECTIVE
  We evaluated the use of alternating cycles of cyclophosphamide/etoposide and carboplatin/etoposide in children entered on National Wilms Tumor Study (NWTS)-5 who were diagnosed between August 1, 1995 and May 31, 2002 and who relapsed after chemotherapy with vincristine, actinomycin D, and doxorubicin (VAD) and radiation therapy (DD-4A).
  
  
  METHODS
  One hundred three patients who relapsed or had progressive disease after initial VAD chemotherapy and radiation therapy were registered on stratum C of the NWTS-5 Relapse protocol. Twelve patients were not evaluable: five due to insufficient data, six due to major protocol violations, and one for refusal of therapy. Among the 91 remaining patients, 14 with stage V Wilms tumor (WT), 1 with contralateral relapse, and 16 who did not achieve a complete response (CR) to the initial three-drug chemotherapy were not included in this analysis. Relapse treatment included alternating courses of the drug pairs cyclophosphamide/etoposide and carboplatin/etoposide, surgery, and radiation therapy.
  
  
  RESULTS
  The outcomes of 60 patients were analyzed. The lung was the only site of relapse for 33 patients; other sites of relapse included the operative bed, the abdomen, and liver. Four-year event-free survival (EFS) and overall survival (OS) were 42.3 and 48.0% respectively for all patients and were 48.9 and 52.8% for those who relapsed in the lungs only. Thrombocytopenia was the most frequent toxicity.
  
  
  CONCLUSIONS
  These results demonstrate that approximately one-half of children with unilateral WT who relapse after initial treatment with VAD and radiation therapy can be successfully retreated.
authors.affiliation: Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.
authors.forename: Marcio
authors.initials: M
authors.lastname: Malogolowkin
authors.forename: Cecilia A
authors.initials: CA
authors.lastname: Cotton
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.forename: Norman E
authors.initials: NE
authors.lastname: Breslow
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Perlman
authors.forename: James
authors.initials: J
authors.lastname: Miser
authors.forename: Michael L
authors.initials: ML
authors.lastname: Ritchey
authors.forename: Patrick R M
authors.initials: PR
authors.lastname: Thomas
authors.forename: Paul E
authors.initials: PE
authors.lastname: Grundy
authors.forename: Giulio J
authors.initials: GJ
authors.lastname: D'Angio
authors.forename: J Bruce
authors.initials: JB
authors.lastname: Beckwith
authors.forename: Robert C
authors.initials: RC
authors.lastname: Shamberger
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Haase
authors.forename: Milton
authors.initials: M
authors.lastname: Donaldson
authors.forename: Robert
authors.initials: R
authors.lastname: Weetman
authors.forename: Max J
authors.initials: MJ
authors.lastname: Coppes
authors.forename: Patricia
authors.initials: P
authors.lastname: Shearer
authors.forename: Peter
authors.initials: P
authors.lastname: Coccia
authors.forename: Morris
authors.initials: M
authors.lastname: Kletzel
authors.forename: Roger
authors.initials: R
authors.lastname: Macklis
authors.forename: Gail
authors.initials: G
authors.lastname: Tomlinson
authors.forename: Vicki
authors.initials: V
authors.lastname: Huff
authors.forename: Robert
authors.initials: R
authors.lastname: Newbury
authors.forename: Douglas
authors.initials: D
authors.lastname: Weeks
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016190:Carboplatin / Q000008:administration & dosage; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging; D012008:Recurrence; D009396:Wilms Tumor / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery
chemical_list: D003609:Dactinomycin; D005047:Etoposide; D004317:Doxorubicin; D016190:Carboplatin