Journal of Clinical Oncology, Vol 6, 1630-1635, Copyright © 1988 by American Society of Clinical Oncology
Reduced therapy for Wilms' tumor: analysis of treatment results from a single institution
JA Wilimas, EC Douglass, S Lewis, D Fairclough, G Fullen, D Parham, AP Kumar, HO Hustu and I Fleming
Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105.
From 1968 to 1986, 192 patients from 0 to 17 years of age were enrolled in
three consecutive protocol-controlled studies of Wilms' tumor at St Jude
Children's Research Hospital. Tumors were completely excised at the time of
diagnosis whenever possible, and patients were subsequently treated with
chemotherapy and radiotherapy according to the initial extent of disease.
All patients received dactinomycin and vincristine, with doxorubicin added
to the regimens in studies 2 and 3. Chemotherapy was extended to 18 months
in study 2 (n = 53), but was limited to 12 months for most patients in
study 3 (n = 107). In the third study, radiation was eliminated altogether
for patients with stage I or II tumors and was reduced to 12 Gy for those
with more advanced disease. Intensification of chemotherapy in study 2
improved the 5-year relapse- free survival rate over that in study 1 (82% v
52%), but the accompanying increase in toxicity was considered
unacceptable. Comparison of 2-year relapse-free survival rates in studies 2
and 3 indicated that the reduction of therapy in the latter trial did not
jeopardize disease control: 88% v 86% for patients with stage II or III
disease, favorable histology; 75% v 57% for the same stages, unfavorable
histology; and 57% v 61% for stage IV patients. At least 80% of all
patients enrolled in study 3 will be long-term survivors. We conclude that
rescheduling of effective antitumor drugs and eliminating or reducing
radiotherapy are feasible alternatives in the treatment of Wilms' tumor
with favorable histologic features.
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