title: Preoperative chemotherapy and local stage III in nephroblastoma.
abstract: The evolution of Nephroblastoma (WT) treatment over the last decades has been one major success around the world. Despite pursuing different upfront treatment approaches the Children's Oncology Group (COG, former National Wilms Tumor Study Group, NWTSG) and the International Society of Paediatric Oncology's Renal Tumor Study Group (SIOP-RTSG) show the same outcome. Treatment starts with preoperative chemotherapy in SIOP-RTSG compared to initial surgery in COG. Response to chemotherapy can be used as a stratification parameter. This allows treating patients with blastemal subtype more aggressively resulting in a better event free survival (EFS). Moreover the percentage of patients with local stage III is less in SIOP-RTSG than in COG studies. Lymph node involvement, in NWTS 5 together with residual microscopic disease, results in a lower EFS in both study groups. But overall survival (OS) is not different comparing patients with or without positive lymph nodes (LN). No other reason for stage III has a significant impact on outcome. The role of radiotherapy for local tumor control in stage III is important, but the radiation dose needs to be questioned as 10.8 Gy used in COG is as efficient as 15 Gy in SIOP-RTSG protocols. In addition in part of low income countries radiotherapy can not be given due to a lack of radiation facilities. Nevertheless some patients are cured without irradiation. The analysis of local stage III patients underlines the importance of preoperative chemotherapy and the need for molecular studies to better stratify patients according to their individual risk.
authors.affiliation: Saarland University, Department of Pediatric Oncology/Hematology, Campus Homburg, 66421 Homburg, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Graf
authors.affiliation: Saarland University, Department of Pediatric Oncology/Hematology, Campus Homburg, 66421 Homburg, Germany.
authors.forename: Rhoikos
authors.initials: R
authors.lastname: Furtwängler
keywords: Nephroblastoma; local stage III; outcome; preoperative chemotherapy
references.citation: Ann Oncol. 2004 May;15(5):808-20
references.pmid: 15111352
references.citation: J Clin Oncol. 2012 Oct 1;30(28):3533-9
references.pmid: 22927531
references.citation: Lancet. 2004 Oct 2-8;364(9441):1229-35
references.pmid: 15464183
references.citation: Klin Padiatr. 2004 May-Jun;216(3):132-40
references.pmid: 15175957
references.citation: Ann Surg. 1994 Nov;220(5):683-90
references.pmid: 7979618
references.citation: J Clin Oncol. 2013 Mar 20;31(9):1196-201
references.pmid: 23382471
references.citation: Expert Rev Anticancer Ther. 2006 Feb;6(2):249-58
references.pmid: 16445377
references.citation: Lancet Oncol. 2013 Mar;14(3):e104-16
references.pmid: 23434340
references.citation: Eur J Cancer. 2007 Nov;43(17):2453-6
references.pmid: 17825551
references.citation: Ann Surg. 1999 Feb;229(2):292-7
references.pmid: 10024113
references.citation: Eur J Cancer. 2012 Nov;48(17):3240-8
references.pmid: 22795263
references.citation: Urol Clin North Am. 2000 Aug;27(3):443-54
references.pmid: 10985144