title: Outcome of patients with Stage II/favorable histology Wilms tumor with and without local tumor spill: a report from the National Wilms Tumor Study Group.
abstract: BACKGROUND
  Intra-operative tumor spill increases the risk of local recurrence of Wilms tumor, and adversely impacts relapse-free (RFS) and overall survival (OS) rates.
  
  
  METHODS
  Surgical checklists, operative notes, institutional pathology reports, central pathology review and flow sheets of 602 patients registered between August 1986 and September 1994 on National Wilms Tumor Study-4 as randomized, followed or switched and coded as Final Stage II, favorable histology (FH) were reviewed. RFS and OS were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were estimated using the Cox model and tested for statistical significance by the log-rank test.
  
  
  RESULTS
  Four hundred ninety-nine patients were found after review to have Stage II, FH Wilms tumor. The 8-year RFS percentages were 85.0% (95% confidence interval (CI): 81.1%, 88.1%) for those with no spill compared to 75.7% (65.8%, 83.2%) for those with spill. The 8-year OS percentages were 95.6% (93.1%, 97.3%) for those with no spill compared to 90.3% (82.2%, 94.9%) for those with spill. The HR for relapse among those with spill was 1.55 ((95%CI: 0.97,2.51), P = 0.067) and the HR for death was 1.94 ((0.92,4.09), P = 0.077).
  
  
  CONCLUSIONS
  RFS and OS were lower for patients who had intra-operative tumor spill. The majority of NWTS Stage II, FH patients with intra-operative tumor spill have an overall excellent outcome when treated with two drug chemotherapy (vincristine and actinomycin D) and no abdominal irradiation.
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.forename: Norman E
authors.initials: NE
authors.lastname: Breslow
authors.forename: Giulio J
authors.initials: GJ
authors.lastname: D'Angio
authors.forename: Marcio H
authors.initials: MH
authors.lastname: Malogolowkin
authors.forename: Michael L
authors.initials: ML
authors.lastname: Ritchey
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Evans
authors.forename: J Bruce
authors.initials: JB
authors.lastname: Beckwith
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Perlman
authors.forename: Robert C
authors.initials: RC
authors.lastname: Shamberger
authors.forename: Susan
authors.initials: S
authors.lastname: Peterson
authors.forename: Paul E
authors.initials: PE
authors.lastname: Grundy
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Dome
authors.forename: Patrick R M
authors.initials: PR
authors.lastname: Thomas
authors.forename: John A
authors.initials: JA
authors.lastname: Kalapurakal
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects*; D011878:Radiotherapy; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D009396:Wilms Tumor / Q000401:mortality / Q000473:pathology / Q000601:surgery*
chemical_list: D003609:Dactinomycin; D014750:Vincristine
keywords: Wilms tumor; actinomycin D; doxorubicin; oncology; radiation therapy; vincristine
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