title: Outcomes of children with favorable histology wilms tumor and peritoneal implants treated in National Wilms Tumor Studies-4 and -5.
abstract: OBJECTIVE
  There are no published reports on the optimal management and survival rates of children with Wilms tumor (WT) and peritoneal implants (PIs).
  
  
  METHODS
  Among favorable histology WT patients enrolled in the National Wilms Tumor Study (NWTS)-4 and NWTS-5, 57 children had PIs at the time of nephrectomy. The median age was 3 years 5 months (range, 3 months to 14 years). The majority of children (42 of 57 [74%)] had Stage III tumors; 15 had Stage IV disease. All patients received multimodality therapy. Of 56 children who underwent primary surgery, 48 (84%) had gross total resection of all tumors. All patients received 3-drug chemotherapy with vincristine, dactinomycin, and doxorubicin. Whole-abdomen radiotherapy (RT) was used in 47 patients (82%), and in 50 patients (88%) the RT dose was 10.5 Gy.
  
  
  RESULTS
  After a median follow-up of 7.5 years, the overall abdominal and systemic tumor control rates were 97% and 93%, respectively. A comparative analysis between children with PIs and those without PIs showed no significant differences in the clinical characteristics between the two groups. The 5-year event-free survival rates with and without PIs were 90% (95% confidence interval, 78-96%) and 83% (95% confidence interval, 81-85%) respectively (p = 0.20).
  
  
  CONCLUSIONS
  Multimodality therapy with surgery, whole-abdomen RT, and three-drug chemotherapy delivered according to the NWTS-4 and -5 protocols resulted in excellent abdominal and systemic tumor control rates. All children should be monitored in long-term surveillance programs for the early detection and management of therapy-related toxicities.
authors.affiliation: Department of Radiation Oncology, Northwestern University, Chicago, IL, USA. j-kalapurakal@northwestern.edu
authors.forename: John A
authors.initials: JA
authors.lastname: Kalapurakal
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.forename: Gerald
authors.initials: G
authors.lastname: Haase
authors.forename: James R
authors.initials: JR
authors.lastname: Anderson
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Dome
authors.forename: Paul E
authors.initials: PE
authors.lastname: Grundy
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D018572:Disease-Free Survival; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009392:Nephrectomy; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000401:mortality / Q000556:secondary / Q000628:therapy*
references.citation: Int J Radiat Oncol Biol Phys. 2004 Apr 1;58(5):1364-8
references.pmid: 15050311
references.citation: Pediatr Blood Cancer. 2008 Feb;50(2):236-41
references.pmid: 17539021
references.citation: Cancer. 1976 Jun;37(6):2768-72
references.pmid: 181122
references.citation: Surg Gynecol Obstet. 1992 Dec;175(6):507-14
references.pmid: 1333095
references.citation: J Clin Oncol. 2001 Apr 1;19(7):1926-34
references.pmid: 11283124
references.citation: Cancer. 1976 Aug;38(2):633-46
references.pmid: 184912
references.citation: J Clin Oncol. 1984 Oct;2(10):1098-101
references.pmid: 6092550
references.citation: Ann Surg. 1978 Apr;187(4):351-6
references.pmid: 206214
references.citation: J Clin Oncol. 1995 Aug;13(8):1851-9
references.pmid: 7636528
references.citation: Int J Cancer. 2008 May 1;122(9):2085-93
references.pmid: 18196579
references.citation: J Clin Oncol. 1998 Jan;16(1):237-45
references.pmid: 9440748
references.citation: Int J Radiat Oncol Biol Phys. 1983 May;9(5):651-7
references.pmid: 6303994
references.citation: Cancer. 1991 Oct 15;68(8):1703-7
references.pmid: 1655223
references.citation: J Clin Oncol. 2002 May 15;20(10):2506-13
references.pmid: 12011129
references.citation: J Clin Oncol. 2004 Dec 15;22(24):4979-90
references.pmid: 15576413
references.citation: Cancer. 1989 Feb 1;63(3):450-3
references.pmid: 2536290
references.citation: Clin Oncol (R Coll Radiol). 1997;9(6):381-4
references.pmid: 9448966
references.citation: Cancer. 1989 Jul 15;64(2):349-60
references.pmid: 2544249
references.citation: Cancer. 1981 May 1;47(9):2302-11
references.pmid: 6164480
references.citation: J Am Coll Surg. 2001 Jan;192(1):63-8; quiz 146
references.pmid: 11192924
references.citation: Int J Radiat Oncol Biol Phys. 1978 Sep-Oct;4(9-10):769-80
references.pmid: 213410
references.citation: J Clin Oncol. 1989 May;7(5):638-47
references.pmid: 2540289
references.citation: Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2):495-9
references.pmid: 12957262