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Congestive Heart Failure After Treatment for Wilms’ Tumor: A Report From the National Wilms’ Tumor Study Group

From the Department of Pediatrics, Roswell Park Cancer Institute, and the Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY; the Department of Biostatistics, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and the Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA.

Address reprint requests to Daniel M. Green, MD, Department of Pediatrics, Roswell Park Cancer Institute, Elm and Carlton Sts, Buffalo, NY 14263; email: daniel.green{at}roswellpark.org

PURPOSE: We determined the frequency of and risk factors for congestive heart failure following treatment for Wilms’ tumor that included doxorubicin.

PATIENTS AND METHODS: Flow sheets and medical records were reviewed to identify cases of congestive heart failure in a cohort of patients treated on National Wilms’ Tumor Studies (NWTS)-1, -2, -3, and -4. The frequency of congestive heart failure was estimated using the Kaplan-Meier method. A case-control study was conducted to determine the relationship among cumulative doxorubicin dose, site(s), total dose of abdominal and thoracic irradiation, sex, and the frequency of congestive heart failure.

RESULTS: The cumulative frequency of congestive heart failure was 4.4% at 20 years after diagnosis among patients treated initially with doxorubicin and 17.4% at 20 years after diagnosis among those treated with doxorubicin for their first or subsequent relapse of Wilms’ tumor. The relative risk (RR) of congestive heart failure was increased in females (RR = 4.5; P = .004) and by cumulative doxorubicin dose (RR = 3.3/100 mg/m²; P < .001), lung irradiation (RR = 1.6/10 Gy; P = .037), and left abdominal irradiation (RR = 1.8/10 Gy; P = .013).

CONCLUSION: We conclude that congestive heart failure is a risk of treatment with doxorubicin for Wilms’ tumor. Additional follow-up of those children treated on NWTS-4 will be necessary to determine if the decrease in dose to 150 mg/m² significantly reduces this risk.

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