Treatment of Wilms tumor relapsing after initial treatment with vincristine, actinomycin D, and doxorubicin. A report from the National Wilms Tumor Study Group.
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.
Malogolowkin
Marcio
M
Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.
Cotton
Cecilia A
CA
Green
Daniel M
DM
Breslow
Norman E
NE
Perlman
Elizabeth
E
Miser
James
J
Ritchey
Michael L
ML
Thomas
Patrick R M
PR
Grundy
Paul E
PE
D'Angio
Giulio J
GJ
Beckwith
J Bruce
JB
Shamberger
Robert C
RC
Haase
Gerald M
GM
Donaldson
Milton
M
Weetman
Robert
R
Coppes
Max J
MJ
Shearer
Patricia
P
Coccia
Peter
P
Kletzel
Morris
M
Macklis
Roger
R
Tomlinson
Gail
G
Huff
Vicki
V
Newbury
Robert
R
Weeks
Douglas
D
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
D003609:Dactinomycin; D005047:Etoposide; D004317:Doxorubicin; D016190:Carboplatin