title: The contribution of chest CT-scan at diagnosis in children with unilateral Wilms' tumour. Results of the SIOP 2001 study.
abstract: BACKGROUND
  The SIOP 2001 nephroblastoma study hypothesised that patients with 'CT-only' pulmonary nodules would have the same outcome as patients with localised disease of same stage and histology.
  
  
  METHODS
  Unilateral Wilms' tumour (WT) patients, who had chest CT scans at diagnosis showing any sized pulmonary nodules undetected on chest X-ray, between November 2001 and November 2009, were selected from the SIOP 2001 database.
  
  
  RESULTS
  Among 2532 WT patients, 103 unilateral nephroblastoma patients with CT-only lung lesions were found. Thirty-seven patients received preoperative treatment according to the localised-disease protocol, and 66 according to the metastatic-disease protocol. The 3-year event-free survival (EFS) was 70% (95% CI: 55-89%) and 77% (95% CI: 66-89%), respectively. Corresponding 3-year overall survival (OS) was 89% (95% CI: 77-100%) and 85% (95% CI: 75-96%), respectively (p-value not significant). EFS and OS of all 2071 patients with true localised disease were 87% (95% CI: 86-89%) and 96% (95% CI: 94-97%), respectively. Patients with metastatic disease (n = 358) had 3-year EFS and OS estimates of 68% (95% CI: 63-74%) and 77% (95% CI: 72-82%), respectively.
  
  
  CONCLUSIONS
  EFS and OS of patients with CT-only lung lesions were inferior to that of true localised-disease patients and superior to that of patients with metastatic disease. However, no significant difference was found in EFS and OS between CT-only patients treated for localised or metastatic disease. The clinician's preference to treat patients with CT-only pulmonary nodules as metastatic disease is not evidence-based. Chest CT at diagnosis does not improve outcome but presents paediatric oncologists with a difficult dilemma.
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands. a.m.smets@amc.uva.nl
authors.forename: Anne M J B
authors.initials: AM
authors.lastname: Smets
authors.forename: Harm
authors.initials: H
authors.lastname: van Tinteren
authors.forename: Christophe
authors.initials: C
authors.lastname: Bergeron
authors.forename: Beatriz
authors.initials: B
authors.lastname: De Camargo
authors.forename: Norbert
authors.initials: N
authors.lastname: Graf
authors.forename: Kathy
authors.initials: K
authors.lastname: Pritchard-Jones
authors.forename: Jan
authors.initials: J
authors.lastname: de Kraker
mesh_terms: D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000556:secondary*; D008297:Male; D014057:Tomography, X-Ray Computed / Q000379:methods*; D009396:Wilms Tumor / Q000000981:diagnostic imaging* / Q000401:mortality