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Abdelhafeez AH, Reljic T, Kumar A, Banu T, Cox S, Davidoff AM, Elgendy A, Ghandour K, Gerstle JT, Karpelowsky J, Kaste SC, Kechiche N, Esiashvili N, Nasir A, Ngongola A, Marollano J, Moreno AA, Muzira A, Parkes J, Saldaña LJ, Shalkow J, Vujanić GM, Velasquez T, Lakhoo K, Mukkada S, Abib S. Evidence-based surgical guidelines for treating children with Wilms tumor in low-resource settings. Pediatr Blood Cancer 2022; 69:e29906. [PMID: 35929184 DOI: 10.1002/pbc.29906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/09/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Survival of Wilms tumor (WT) is > 90% in high-resource settings but < 30% in low-resource settings. Adapting a standardized surgical approach to WT is challenging in low-resource settings, but a local control strategy is crucial to improving outcomes. OBJECTIVE Provide resource-sensitive recommendations for the surgical management of WT. METHODS We performed a systematic review of PubMed and EMBASE through July 7, 2020, and used the GRADE approach to assess evidence and recommendations. RECOMMENDATIONS Initiation of treatment should be expedited, and surgery should be done in a high-volume setting. Cross-sectional imaging should be done to optimize preoperative planning. For patients with typical clinical features of WT, biopsy should not be done before chemotherapy, and neoadjuvant chemotherapy should precede surgical resection. Also, resection should include a large transperitoneal laparotomy, adequate lymph node sampling, and documentation of staging findings. For WT with tumor thrombus in the inferior vena cava, neoadjuvant chemotherapy should be given before en bloc resection of the tumor and thrombus and evaluation for viable tumor thrombus. For those with bilateral WT, neoadjuvant chemotherapy should be given for 6-12 weeks. Neither routine use of complex hilar control techniques during nephron-sparing surgery nor nephron-sparing resection for unilateral WT with a normal contralateral kidney is recommended. When indicated, postoperative radiotherapy should be administered within 14 days of surgery. Post-chemotherapy pulmonary oligometastasis should be resected when feasible, if local protocols allow omission of whole-lung irradiation in patients with nonanaplastic histology stage IV WT with pulmonary metastasis without evidence of extrapulmonary metastasis. CONCLUSION We provide evidence-based recommendations for the surgical management of WT, considering the benefits/risks associated with limited-resource settings.
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Affiliation(s)
- Abdelhafeez H Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.,University of Tennessee Health Science Center, Memphis, Tennessee
| | - Tea Reljic
- Office of Research Conduct and Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Ambuj Kumar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
| | - Sharon Cox
- Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.,University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ahmed Elgendy
- Surgical Oncology Unit, Tanta University & Department of Pediatric Surgery, Children's Cancer Hospital - Egypt, Tanta, Gharbia, Egypt
| | - Khalil Ghandour
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - J Ted Gerstle
- Pediatric Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan Karpelowsky
- The Children's Hospital at Westmead, Division of Child & Adolescent Health, The University of Sydney, Children's Cancer Research Unit -Kids Research Institute, Sydney, Australia
| | - Sue C Kaste
- University of Tennessee Health Science Center, Memphis, Tennessee.,Department of Radiaology and Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nahla Kechiche
- Department of Pediatric Surgery, University Hospital Monastir, LR12SP13, University of Monastir, Monastir, Tunisia
| | - Natia Esiashvili
- Department of Radiation Oncology, Emory Winship Cancer Institute, Atlanta, Georgia
| | - Abdulrasheed Nasir
- Department of Surgery, University of Ilorin Teaching Hospital/University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Amon Ngongola
- Department of Pediatric Surgery, University Teaching Hospital, Lusaka, Zambia
| | | | - Amabelle A Moreno
- Division of Pediatric Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Arlene Muzira
- Department of Paediatric Surgery, Uganda Cancer Institute, Kampala, Uganda
| | - Jeannette Parkes
- Department of Radiation Oncology, University of Cape Town, Cape Town, South Africa
| | - Lily J Saldaña
- Pediatric Surgery Service, Instituto Nacional de Salud del Niño de San Borja, Lima, Peru
| | - Jaime Shalkow
- Pediatric Surgery, National Institute of Paediatrics and ABC Cancer Centre, Mexico City, Mexico
| | - Gordan M Vujanić
- Department of Pediatric Pathology, Sidra Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Thelma Velasquez
- Department of Oncology, Unidad Nacional de Oncologia Pediatrica, Guatemala City, Guatemala
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, Oxford University, Oxford, UK
| | - Sheena Mukkada
- University of Tennessee Health Science Center, Memphis, Tennessee.,Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Simone Abib
- Department of Pediatric Surgery, Pediatric Oncology Institute - GRAACC - Federal University of São Paulo, São Paulo, Brazil
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2
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Brok JS, Shelmerdine S, Damsgaard F, Smets A, Irtan S, Swinson S, Hedayati V, Jacob J, Nair A, Oostveen M, Pritchard-Jones K, Olsen Ø. The clinical impact of observer variability in lung nodule classification in children with Wilms tumour. Pediatr Blood Cancer 2022; 69:e29759. [PMID: 35652617 PMCID: PMC7615195 DOI: 10.1002/pbc.29759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate the extent to which observer variability of computed tomography (CT) lung nodule assessment may affect clinical treatment stratification in Wilms tumour (WT) patients, according to the recent Société Internationale d'Oncologie Pédiatrique Renal Tumour Study Group (SIOP-RTSG) UMBRELLA protocol. METHODS I: CT thoraces of children with WT submitted for central review were used to estimate size distribution of lung metastases. II: Scans were selected for blinded review by five radiologists to determine intra- and inter-observer variability. They assessed identical scans on two occasions 6 months apart. III: Monte Carlo simulation (MCMC) was used to predict the clinical impact of observer variation when applying the UMBRELLA protocol size criteria. RESULTS Lung nodules were found in 84 out of 360 (23%) children with WT. For 21 identified lung nodules, inter-observer limits of agreement (LOA) for the five readers were ±2.4 and ±1.4 mm (AP diameter), ±1.9 and ±1.8 mm (TS diameter) and ±2.0 and ±2.4 mm (LS diameter) at assessments 1 and 2. Intra-observer LOA across the three dimensions were ±1.5, ±2.2, ±3.5, ±3.1 and ±2.6 mm (readers 1-5). MCMC demonstrated that 17% of the patients with a 'true' nodule size of ≥3 mm will be scored as <3 mm, and 21% of the patients with a 'true' nodule size of <3 mm will be scored as being ≥3 mm. CONCLUSION A significant intra-inter observer variation was found when measuring lung nodules on CT for patients with WT. This may have significant implications on treatment stratification, and thereby outcome, when applying a threshold of ≥3 mm for a lung nodule to dictate metastatic status.
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Affiliation(s)
- Jesper Sune Brok
- Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Susan Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Frederikke Damsgaard
- Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Smets
- Department of Radiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Sabine Irtan
- Department of Visceral and Neonatal Paediatric Surgery, Sorbonne University, Armand Trousseau Hospital - APHP, Paris, France
| | | | - Venus Hedayati
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK
- Department of Respiratory Medicine, University College London, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Minou Oostveen
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Øystein Olsen
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK
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3
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de Aguirre-Neto JC, de Camargo B, van Tinteren H, Bergeron C, Brok J, Ramírez-Villar G, Verschuur A, Furtwängler R, Howell L, Saunders D, Olsen O, Coulomb A, Vokuhl C, Godzinski J, Smets AM, Vujanic GM, van den Heuvel-Eibrink MM, Graf N, Pritchard-Jones K. International Comparisons of Clinical Demographics and Outcomes in the International Society of Pediatric Oncology Wilms Tumor 2001 Trial and Study. JCO Glob Oncol 2022; 8:e2100425. [PMID: 35537105 PMCID: PMC9126524 DOI: 10.1200/go.21.00425] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
International comparisons of patient demographics, tumor characteristics, and survival can shed light on areas for health care system improvement. The International Society of Pediatric Oncology Wilms Tumor 2001 trial/study registered patients through national clinical study groups in Western Europe and Brazil. This retrospective post hoc analysis of the International Society of Pediatric Oncology Wilms Tumor 2001 database aims to make visible and suggest reasons for any variations in outcomes. International variation in Wilms tumor survival parallels disease burden at diagnosis.![]()
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Affiliation(s)
| | | | - Harm van Tinteren
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Christophe Bergeron
- Centre Léon Bérard, Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Jesper Brok
- Department of Paediatric Oncology and Haematology, Rigshospitalet, Copenhagen, Denmark
| | | | - Arnauld Verschuur
- Service d'hématologie-oncologie Pédiatrique, Hôpital de la Timone, Marseille, France
| | - Rhoikos Furtwängler
- Department of Pediatric Hematology and Oncology, Saarland University Hospital, Homburg, Germany
| | - Lisa Howell
- Paediatric Oncology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Daniel Saunders
- Paediatric Radiotherapy, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Oystein Olsen
- Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Aurore Coulomb
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Armand Trousseau, Paris, France
| | | | - Jan Godzinski
- Department of Paed. Surgery, Marciniak Hospital, Wroclaw, Poland
| | - Anne M Smets
- Radiology, Amsterdam University Medical Centre-AMC, Amsterdam, the Netherlands
| | | | | | - Norbert Graf
- Department of Pediatric Hematology and Oncology, Saarland University Hospital, Homburg, Germany
| | - Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, Developmental Biology and Cancer Research and Teaching Department, University College London, London, United Kingdom
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4
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Theilen TM, Braun Y, Bochennek K, Rolle U, Fiegel HC, Friedmacher F. Multidisciplinary Treatment Strategies for Wilms Tumor: Recent Advances, Technical Innovations and Future Directions. Front Pediatr 2022; 10:852185. [PMID: 35911825 PMCID: PMC9333359 DOI: 10.3389/fped.2022.852185] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Significant progress has been made in the management of Wilms tumor (WT) in recent years, mostly as a result of collaborative efforts and the implementation of protocol-driven, multimodal therapy. This article offers a comprehensive overview of current multidisciplinary treatment strategies for WT, whilst also addressing recent technical innovations including nephron-sparing surgery (NSS) and minimally invasive approaches. In addition, surgical concepts for the treatment of metastatic disease, advances in tumor imaging technology and potentially prognostic biomarkers will be discussed. Current evidence suggests that, in experienced hands and selected cases, laparoscopic radical nephrectomy and laparoscopic-assisted partial nephrectomy for WT may offer the same outcome as the traditional open approach. While NSS is the standard procedure for bilateral WT, NSS has evolved as an alternative technique in patients with smaller unilateral WT and in cases with imminent renal failure. Metastatic disease of the lung or liver that is associated with WT is preferably treated with a three-drug chemotherapy and local radiation therapy. However, surgical sampling of lung nodules may be advisable in persistent nodules before whole lung irradiation is commenced. Several tumor markers such as loss of heterozygosity of chromosomes 1p/16q, 11p15 and gain of function at 1q are associated with an increased risk of recurrence or a decreased risk of overall survival in patients with WT. In summary, complete resection with tumor-free margins remains the primary surgical aim in WT, while NSS and minimally invasive approaches are only suitable in a subset of patients with smaller WT and low-risk disease. In the future, advances in tumor imaging technology may assist the surgeon in defining surgical resection margins and additional biomarkers may emerge as targets for development of new diagnostic tests and potential therapies.
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Affiliation(s)
- Till-Martin Theilen
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Yannick Braun
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Konrad Bochennek
- Division of Pediatric Hematology and Pediatric Oncology, Hospital for Children and Adolescents, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Udo Rolle
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Henning C Fiegel
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Florian Friedmacher
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
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5
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Graf N, Bergeron C, Brok J, de Camargo B, Chowdhury T, Furtwängler R, Gessler M, Godzinski J, Pritchard-Jones K, Ramirez-Villar GL, Rübe C, Sandstedt B, Schenk JP, Spreafico F, Sudour-Bonnange H, van Tinteren H, Verschuur A, Vujanic G, van den Heuvel-Eibrink MM. Fifty years of clinical and research studies for childhood renal tumors within the International Society of Pediatric Oncology (SIOP). Ann Oncol 2021; 32:1327-1331. [PMID: 34416363 DOI: 10.1016/j.annonc.2021.08.1749] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/08/2021] [Indexed: 01/01/2023] Open
Affiliation(s)
- N Graf
- Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany.
| | - C Bergeron
- Department of Paediatric Haemato-Oncology, Centre Léon Bérard, Lyon, France
| | - J Brok
- Department of Pediatric Oncology and Hematology, Rigshospitalet, Copenhagen, Denmark
| | - B de Camargo
- Research Center, Instituto Nacional do Cancer, Rio de Janeiro, Brazil
| | - T Chowdhury
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - R Furtwängler
- Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany
| | - M Gessler
- Theodor-Boveri-Institute/Biocenter and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - J Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Fieldorfa 2, Poland; Department of Paediatric Traumatology and Emergency Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - K Pritchard-Jones
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, University College London, London, UK
| | - G L Ramirez-Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - C Rübe
- Department of Radiation Oncology, Saarland University, Homburg, Germany
| | - B Sandstedt
- Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - J-P Schenk
- Pediatric Radiology Section, Department for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - F Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - H Sudour-Bonnange
- Centre Oscar Lambret, Department of Children and AJA Oncology, Lille, France
| | - H van Tinteren
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - A Verschuur
- Department of Pediatric Oncology, Hôpital d'Enfants de la Timone, Marseille, France
| | - G Vujanic
- Department of Pathology, Sidra Medicine and Weill Cornell Medicine - Qatar, Doha, Qatar
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6
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Spreafico F, Fernandez CV, Brok J, Nakata K, Vujanic G, Geller JI, Gessler M, Maschietto M, Behjati S, Polanco A, Paintsil V, Luna-Fineman S, Pritchard-Jones K. Wilms tumour. Nat Rev Dis Primers 2021; 7:75. [PMID: 34650095 DOI: 10.1038/s41572-021-00308-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 02/08/2023]
Abstract
Wilms tumour (WT) is a childhood embryonal tumour that is paradigmatic of the intersection between disrupted organogenesis and tumorigenesis. Many WT genes play a critical (non-redundant) role in early nephrogenesis. Improving patient outcomes requires advances in understanding and targeting of the multiple genes and cellular control pathways now identified as active in WT development. Decades of clinical and basic research have helped to gradually optimize clinical care. Curative therapy is achievable in 90% of affected children, even those with disseminated disease, yet survival disparities within and between countries exist and deserve commitment to change. Updated epidemiological studies have also provided novel insights into global incidence variations. Introduction of biology-driven approaches to risk stratification and new drug development has been slower in WT than in other childhood tumours. Current prognostic classification for children with WT is grounded in clinical and pathological findings and in dedicated protocols on molecular alterations. Treatment includes conventional cytotoxic chemotherapy and surgery, and radiation therapy in some cases. Advanced imaging to capture tumour composition, optimizing irradiation techniques to reduce target volumes, and evaluation of newer surgical procedures are key areas for future research.
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Affiliation(s)
- Filippo Spreafico
- Department of Medical Oncology and Hematology, Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Conrad V Fernandez
- Department of Paediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jesper Brok
- Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - James I Geller
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Cincinnati, OH, USA
| | - Manfred Gessler
- Theodor-Boveri-Institute, Developmental Biochemistry, and Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Wuerzburg, Germany
| | - Mariana Maschietto
- Research Center, Boldrini Children's Hospital, Genetics and Molecular Biology, Institute of Biology, State University of Campinas, Campinas, SP, Brazil
| | - Sam Behjati
- Wellcome Sanger Institute, Hinxton, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Angela Polanco
- National Cancer Research Institute Children's Group Consumer Representative, London, UK
| | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sandra Luna-Fineman
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Paediatrics, University of Colorado, Aurora, CO, USA
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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7
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Dome JS, Mullen EA, Dix DB, Gratias EJ, Ehrlich PF, Daw NC, Geller JI, Chintagumpala M, Khanna G, Kalapurakal JA, Renfro LA, Perlman EJ, Grundy PE, Fernandez CV. Impact of the First Generation of Children's Oncology Group Clinical Trials on Clinical Practice for Wilms Tumor. J Natl Compr Canc Netw 2021; 19:978-985. [PMID: 34416705 DOI: 10.6004/jnccn.2021.7070] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Abstract
Refinements in surgery, radiation therapy, and chemotherapy since the mid-20th century have resulted in a survival rate exceeding 90% for patients with Wilms tumor (WT). Although this figure is remarkable, a significant proportion of patients continue to have event-free survival (EFS) estimates of <75%, and nearly 25% of survivors experience severe chronic medical conditions. The first-generation Children's Oncology Group (COG) renal tumor trials (AREN '0'), which opened to enrollment in 2006, focused on augmenting treatment regimens for WT subgroups with predicted EFS <75% to 80%, including those with the adverse prognostic marker of combined loss of heterozygosity (LOH) at chromosomes 1p/16q, pulmonary metastasis with incomplete lung nodule response after 6 weeks of chemotherapy, bilateral disease, and anaplastic histology. Conversely, therapy was reduced for patient subgroups with good outcomes and potential for long-term toxicity, such as those with lung metastasis with complete lung nodule response after 6 weeks of chemotherapy. This article summarizes the key findings of the first-generation COG renal tumor studies and their implications for clinical practice.
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Affiliation(s)
- Jeffrey S Dome
- Division of Oncology, Center for Cancer and Blood Disorders, Children's National Hospital and the Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Elizabeth A Mullen
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - David B Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter F Ehrlich
- Department of Pediatric Surgery, University of Michigan, CS Mott Children's Hospital, Ann Arbor, Michigan
| | - Najat C Daw
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James I Geller
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Geetika Khanna
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern University School of Medicine, Chicago, Illinois
| | - Lindsay A Renfro
- Children's Oncology Group and Division of Biostatistics, University of Southern California, Los Angeles, California
| | - Elizabeth J Perlman
- Department of Pathology, Northwestern University Feinberg School of Medicine, and the Robert H. Lurie Cancer Center, Chicago, Illinois
| | - Paul E Grundy
- Department of Pediatrics, University of Alberta Hospital, Edmonton, Alberta, Canada; and
| | - Conrad V Fernandez
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
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8
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Groenendijk A, Spreafico F, de Krijger RR, Drost J, Brok J, Perotti D, van Tinteren H, Venkatramani R, Godziński J, Rübe C, Geller JI, Graf N, van den Heuvel-Eibrink MM, Mavinkurve-Groothuis AMC. Prognostic Factors for Wilms Tumor Recurrence: A Review of the Literature. Cancers (Basel) 2021; 13:cancers13133142. [PMID: 34201787 PMCID: PMC8268923 DOI: 10.3390/cancers13133142] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/18/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary A Wilms tumor is a childhood kidney tumor. In high-income countries, 90% of patients with this tumor survive. However, the tumor recurs in 15% of patients. It is important to identify the patients at risk of recurrence in order to adjust treatment in such a way that recurrence may potentially be prevented. However, we are currently unable to determine precisely which patients are at risk of recurrence. Therefore, we present an overview of factors that influence the risk of recurrence, also known as prognostic factors. These factors range from patient-, tumor- and treatment-related characteristics to geographic and socioeconomic factors. In addition to these factors, biological markers, such as genetic alterations, should be studied more intensively as these markers may be able to better identify patients at risk of tumor recurrence. Abstract In high-income countries, the overall survival of children with Wilms tumors (WT) is ~90%. However, overall, 15% of patients experience tumor recurrence. The adverse prognostic factors currently used for risk stratification (advanced stage, high risk histology, and combined loss of heterozygosity at 1p and 16q in chemotherapy-naïve WTs) are present in only one third of these cases, and the significance of these factors is prone to change with advancing knowledge and improved treatment regimens. Therefore, we present a comprehensive, updated overview of the published prognostic variables for WT recurrence, ranging from patient-, tumor- and treatment-related characteristics to geographic and socioeconomic factors. Improved first-line treatment regimens based on clinicopathological characteristics and advancing knowledge on copy number variations unveil the importance of further investigating the significance of biological markers for WT recurrence in international collaborations.
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Affiliation(s)
- Alissa Groenendijk
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Correspondence:
| | - Filippo Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Ronald R. de Krijger
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jarno Drost
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Oncode Institute, 3584 CS Utrecht, The Netherlands
| | - Jesper Brok
- Department of Pediatric Oncology and Hematology, Rigshospitalet, 2100 Copenhagen, Denmark;
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Daniela Perotti
- Molecular Bases of Genetic Risk and Genetic Testing Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
| | | | - Jan Godziński
- Department of Pediatric Surgery, Marciniak Hospital, Fieldorfa 2, 54-049 Wroclaw, Poland;
- Department of Pediatric Traumatology and Emergency Medicine, Wroclaw Medical University, Bujwida 44a, 50-345 Wroclaw, Poland
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg, Germany;
| | - James I. Geller
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA;
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg, Germany;
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
| | - Annelies M. C. Mavinkurve-Groothuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
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9
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Affiliation(s)
- David B. Dix
- David B. Dix, MBChB, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada; Conrad V. Fernandez, MD, IWK Health Centre, Halifax, Nova Scotia, Canada; Yueh-Yun Chi, PhD, University of Florida, Gainesville, FL; Lindsay A. Renfro, PhD, University of Southern California Health Sciences Center, Los Angeles, CA; and Jeffrey S. Dome, MD, PhD, George Washington University, Washington, DC
| | - Conrad V. Fernandez
- David B. Dix, MBChB, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada; Conrad V. Fernandez, MD, IWK Health Centre, Halifax, Nova Scotia, Canada; Yueh-Yun Chi, PhD, University of Florida, Gainesville, FL; Lindsay A. Renfro, PhD, University of Southern California Health Sciences Center, Los Angeles, CA; and Jeffrey S. Dome, MD, PhD, George Washington University, Washington, DC
| | - Yueh-Yun Chi
- David B. Dix, MBChB, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada; Conrad V. Fernandez, MD, IWK Health Centre, Halifax, Nova Scotia, Canada; Yueh-Yun Chi, PhD, University of Florida, Gainesville, FL; Lindsay A. Renfro, PhD, University of Southern California Health Sciences Center, Los Angeles, CA; and Jeffrey S. Dome, MD, PhD, George Washington University, Washington, DC
| | - Lindsay A. Renfro
- David B. Dix, MBChB, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada; Conrad V. Fernandez, MD, IWK Health Centre, Halifax, Nova Scotia, Canada; Yueh-Yun Chi, PhD, University of Florida, Gainesville, FL; Lindsay A. Renfro, PhD, University of Southern California Health Sciences Center, Los Angeles, CA; and Jeffrey S. Dome, MD, PhD, George Washington University, Washington, DC
| | - Jeffrey S. Dome MD
- David B. Dix, MBChB, British Columbia's Children's Hospital, Vancouver, British Columbia, Canada; Conrad V. Fernandez, MD, IWK Health Centre, Halifax, Nova Scotia, Canada; Yueh-Yun Chi, PhD, University of Florida, Gainesville, FL; Lindsay A. Renfro, PhD, University of Southern California Health Sciences Center, Los Angeles, CA; and Jeffrey S. Dome, MD, PhD, George Washington University, Washington, DC
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Mullen EA, Khanna G, Geller JI, Fernandez CV, Dome JS. Reply to L. Xie et al. J Clin Oncol 2019; 37:1264-1265. [PMID: 30875281 DOI: 10.1200/jco.19.00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elizabeth A Mullen
- Elizabeth A. Mullen, MD, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Geetika Khanna, MD, Washington University School of Medicine, St Louis, MO; James I. Geller, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Conrad V. Fernandez, MD, Dalhousie University, Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, MD, PhD, Children's National Health System, Washington, DC
| | - Geetika Khanna
- Elizabeth A. Mullen, MD, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Geetika Khanna, MD, Washington University School of Medicine, St Louis, MO; James I. Geller, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Conrad V. Fernandez, MD, Dalhousie University, Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, MD, PhD, Children's National Health System, Washington, DC
| | - James I Geller
- Elizabeth A. Mullen, MD, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Geetika Khanna, MD, Washington University School of Medicine, St Louis, MO; James I. Geller, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Conrad V. Fernandez, MD, Dalhousie University, Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, MD, PhD, Children's National Health System, Washington, DC
| | - Conrad V Fernandez
- Elizabeth A. Mullen, MD, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Geetika Khanna, MD, Washington University School of Medicine, St Louis, MO; James I. Geller, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Conrad V. Fernandez, MD, Dalhousie University, Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, MD, PhD, Children's National Health System, Washington, DC
| | - Jeffrey S Dome
- Elizabeth A. Mullen, MD, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Geetika Khanna, MD, Washington University School of Medicine, St Louis, MO; James I. Geller, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Conrad V. Fernandez, MD, Dalhousie University, Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, MD, PhD, Children's National Health System, Washington, DC
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Abstract
Although differences exist in treatment and risk-stratification strategies for children with Wilms tumor (WT) between the European [International Society of Paediatric Oncology (SIOP)] and American [Children's Oncology Group (COG)] study groups, outcomes are very similar, with an overall survival of > 85%. Future strategies aim to de-intensify treatment and reduce toxicity for children with a low risk of relapse and intensify treatment for children with high-risk disease. For metastatic WT, response of lung nodules to chemotherapy is used as a marker to modify treatment intensity. For recurrent WT, a unified approach based on the use of agents that were not used for primary therapy is being introduced. Irinotecan is being explored as a new strategy in both metastatic and relapsed WT. Introduction of biology-driven approaches to risk stratification and new drug treatments has been slower in WT than in some other childhood cancers. While several new biological pathways have been identified recently in WT, their individual rarity has hampered their translation into clinical utility. Identification of robust prognostic factors requires extensive international collaborative studies because of the low proportion who relapse or die. Molecular profiling studies are in progress that should ultimately improve both risk classification and signposting to more targeted therapies for the small group for whom current therapies fail. Accrual of patients with WT to early-phase trials has been low, and the efficacy of these new agents has so far been very disappointing. Better in vitro model systems to test mechanistic dependence are needed so available new agents can be more rationally prioritized for recruitment of children with WT to early-phase trials.
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Affiliation(s)
- Radna Minou Oostveen
- UCL Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Kathy Pritchard-Jones
- UCL Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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12
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Green DM. Treatment of Stage IV Favorable Histology Wilms Tumor With Lung Metastases. J Clin Oncol 2018; 36:JCO1800101. [PMID: 30212293 DOI: 10.1200/jco.18.00101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Daniel M Green
- Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
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13
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Dix DB, Seibel NL, Chi YY, Khanna G, Mullen EA, Geller JI, Kalapurakal JA, Ehrlich PF, Malogolowkin MH, Fernandez CV, Dome JS. Reply to D.M. Green. J Clin Oncol 2018; 36:JCO1800659. [PMID: 30212299 DOI: 10.1200/jco.18.00659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- David B Dix
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Nita L Seibel
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Yueh-Yun Chi
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Geetika Khanna
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Elizabeth A Mullen
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - James I Geller
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - John A Kalapurakal
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Peter F Ehrlich
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Marcio H Malogolowkin
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Conrad V Fernandez
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jeffrey S Dome
- David B. Dix, British Columbia Children's Hospital, Vancouver, BC, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University, Chicago, IL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Conrad V. Fernandez, IWK Health Center, Dalhousie University, Halifax, NS, Canada; and Jeffrey S. Dome, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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Dix DB, Seibel NL, Chi YY, Khanna G, Gratias E, Anderson JR, Mullen EA, Geller JI, Kalapurakal JA, Paulino AC, Perlman EJ, Ehrlich PF, Malogolowkin M, Gastier-Foster JM, Wagner E, Grundy PE, Fernandez CV, Dome JS. Treatment of Stage IV Favorable Histology Wilms Tumor With Lung Metastases: A Report From the Children's Oncology Group AREN0533 Study. J Clin Oncol 2018; 36:1564-1570. [PMID: 29659330 DOI: 10.1200/jco.2017.77.1931] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose The National Wilms Tumor Study (NWTS) treatment of favorable histology Wilms tumor with lung metastases was vincristine/dactinomycin/doxorubicin (DD4A) and lung radiation therapy (RT). The AREN0533 study applied a new risk stratification and treatment strategy to improve event-free survival (EFS) while reducing exposure to lung RT. Methods Patients with favorable histology Wilms tumor and isolated lung metastases showing complete lung nodule response (CR) after 6 weeks of DD4A continued receiving chemotherapy without lung RT. Patients with incomplete response (IR) or loss of heterozygosity at chromosomes 1p/16q received lung RT and four cycles of cyclophosphamide/etoposide in addition to DD4A drugs (Regimen M). AREN0533 was designed to preserve a 4-year EFS of 85% for lung nodule CR and improve 4-year EFS from 75% to 85% for lung nodule IR. Results Among 292 assessable patients, 133 had CR and 159 had IR. For patients with CR, 4-year EFS and overall survival (OS) estimates were 79.5% (95% CI, 71.2% to 87.8%) and 96.1% (95% CI, 92.1% to 100%), respectively. Expected versus observed event rates were 15% and 20.2% ( P = .052), respectively. For patients with IR, 4-year EFS and OS estimates were 88.5% (95% CI, 81.8% to 95.3%) and 95.4% (95% CI, 90.9% to 99.8%), respectively. Expected versus observed event rates were 25% and 12.2% ( P < .001), respectively. Overall, 4-year EFS and OS were 85.4% (95% CI, 80.5% to 90.2%) and 95.6% (95% CI, 92.8% to 98.4%) compared with 72.5% (95% CI, 66.9% to 78.1%; P < .001) and 84.0% (95% CI, 79.4% to 88.6%; P < .001), respectively, in the predecessor NWTS-5 study. Conclusion Excellent OS was achieved after omission of primary lung RT in patients with lung nodule CR, although there were more events than expected. EFS was significantly improved, with excellent OS, in patients with lung nodule IR using four cycles of cyclophosphamide/etoposide in addition to DD4A drugs. The overall AREN0533 treatment strategy yielded EFS and OS estimates that were superior to previous studies.
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Affiliation(s)
- David B Dix
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Nita L Seibel
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Yueh-Yun Chi
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Geetika Khanna
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Eric Gratias
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - James R Anderson
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth A Mullen
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - James I Geller
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - John A Kalapurakal
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Arnold C Paulino
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth J Perlman
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Peter F Ehrlich
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Marcio Malogolowkin
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Julie M Gastier-Foster
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth Wagner
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Paul E Grundy
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Conrad V Fernandez
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Jeffrey S Dome
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
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15
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Verhagen MV, Smets AMJB, van Schuppen J, Deurloo EE, Schaefer-Prokop C. The impact of reconstruction techniques on observer performance for the detection and characterization of small pulmonary nodules in chest CT of children under 13 years. Eur J Radiol 2018; 100:142-146. [PMID: 29496073 DOI: 10.1016/j.ejrad.2018.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 11/29/2017] [Accepted: 01/15/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare three different reconstruction techniques of CT data for the detection of pulmonary nodules in children under 13 years. Secondly to assess the prevalence of perifissural nodular opacities. MATERIALS AND METHODS The study consisted of chest CTs of 31 children (median age 6.9 years, range 2.1-12.7), of whom 17 had known extra-thoracic malignancies. Four observers assessed three techniques for the presence of nodules: axial 5 mm maximum intensity projections (MIPs) used in conjunction with 1 mm slices (mode A), 1 mm slices alone (mode B) and 3 mm slices (mode C). All modes were available in 3D. Per mode sensitivities were determined above a certain threshold of reader agreement. Confidence level and reader agreement for identification of an opacity as nodule served as surrogate for quality of nodule characterization. RESULTS 103 nodules (median size 2.0 mm) were detected. Mode A yielded the highest interreader agreement (κ 0.336) and a superior sensitivity (71%, p = 0.003) compared to mode B and C (κ 0.218, sensitivity 57% and κ 0.247, sensitivity 56%, respectively). Mode B provided the highest confidence level and interreader agreement with respect to nodule identification (mean 4.3/5, κw 0.508). Double reading improved and evened interreader agreement for all modes (κ 0.450), mode A maintained the highest sensitivity (89.1%, p = 0.05-0.08). A median of 1 intrapulmonary lymph node/patient was seen in children with and without malignancy. CONCLUSION MIP improves the detection of pulmonary nodules in chest CTs of children, but overall interreader agreement is only fair. Double reading represents a powerful tool to increase diagnostic reliability in chest CTs of children with a malignancy. Nodule characterization is best with 1 mm slices. Intrapulmonary lymph nodes occur in children with and without malignancy.
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Affiliation(s)
- Martijn V Verhagen
- Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands.
| | - Anne M J B Smets
- Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands.
| | - Joost van Schuppen
- Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands.
| | - Eline E Deurloo
- Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, Netherlands.
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16
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van den Heuvel-Eibrink MM, Hol JA, Pritchard-Jones K, van Tinteren H, Furtwängler R, Verschuur AC, Vujanic GM, Leuschner I, Brok J, Rübe C, Smets AM, Janssens GO, Godzinski J, Ramírez-Villar GL, de Camargo B, Segers H, Collini P, Gessler M, Bergeron C, Spreafico F, Graf N. Position paper: Rationale for the treatment of Wilms tumour in the UMBRELLA SIOP-RTSG 2016 protocol. Nat Rev Urol 2017; 14:743-752. [PMID: 29089605 DOI: 10.1038/nrurol.2017.163] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Renal Tumour Study Group of the International Society of Paediatric Oncology (SIOP-RTSG) has developed a new protocol for the diagnosis and treatment of childhood renal tumours, the UMBRELLA SIOP-RTSG 2016 (the UMBRELLA protocol), to continue international collaboration in the treatment of childhood renal tumours. This protocol will support integrated biomarker and imaging research, focussing on assessing the independent prognostic value of genomic changes within the tumour and the volume of the blastemal component that survives preoperative chemotherapy. Treatment guidelines for Wilms tumours in the UMBRELLA protocol include recommendations for localized, metastatic, and bilateral disease, for all age groups, and for relapsed disease. These recommendations have been established by a multidisciplinary panel of leading experts on renal tumours within the SIOP-RTSG. The UMBRELLA protocol should promote international collaboration and research and serve as the SIOP-RTSG best available treatment standard.
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Affiliation(s)
- Marry M van den Heuvel-Eibrink
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
| | - Janna A Hol
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
| | - Kathy Pritchard-Jones
- Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, United Kingdom
| | - Harm van Tinteren
- Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Rhoikos Furtwängler
- Department of Paediatric Oncology & Haematology, Saarland University, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Arnauld C Verschuur
- Department of Paediatric Oncology & Haematology, La Timone Children's Hospital, 264 Rue Saint-Pierre, 13385, Marseille, France
| | - Gordan M Vujanic
- Department of Cellular Pathology, University Hospital of Wales, Cardiff University School of Medicine, Heath Park, Eastern Ave, Cardiff, CF14 4XW, United Kingdom
| | - Ivo Leuschner
- Kiel Paediatric Tumour Registry, Department of Paediatric Pathology, University Hospital of Kiel, Christian-Albrechts-Platz 4, 24118, Kiel, Germany
| | - Jesper Brok
- Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, United Kingdom
| | - Christian Rübe
- Department of Radiotherapy, University Hospital of the Saarland, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Anne M Smets
- Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Geert O Janssens
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan Godzinski
- Department of Paediatric Surgery, Marciniak Hospital, Fieldorfa 2, 54-049, Wroclaw, Poland
- Department of Paediatric Traumatology and Emergency Medicine, Medical University, Wybrzeze Ludwika Pasteura 1, 50-367, Wroclaw, Poland
| | - Gema L Ramírez-Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, S/N, 41013 Seville, Spain
| | - Beatriz de Camargo
- Paediatric Haematology-Oncology Program, Instituto Nacional de Cancer (INCA), Praça Cruz Vermelha, 23, Rio de Janeiro, 20230-130, Brazil
| | - Heidi Segers
- Department of Paediatric Oncology, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Paola Collini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Manfred Gessler
- Biocenter of the University of Wuerzburg, Developmental Biochemistry, and Comprehensive Cancer Center Mainfranken, Josef-Schneider-Straße 6, 97080, Wuerzburg, Germany
| | - Christophe Bergeron
- Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Filippo Spreafico
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Norbert Graf
- Department of Paediatric Oncology & Haematology, Saarland University, Kirrberger Str. 100, 66421, Homburg, Germany
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17
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Prasad M, Vora T, Agarwala S, Laskar S, Arora B, Bansal D, Kapoor G, Chinnaswamy G, Radhakrishnan V, Kaur T, Rath GK, Bakhshi S. Management of Wilms Tumor: ICMR Consensus Document. Indian J Pediatr 2017; 84:437-445. [PMID: 28367612 DOI: 10.1007/s12098-017-2305-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/31/2017] [Indexed: 11/26/2022]
Abstract
Wilms tumor (WT) is the most common renal tumor of childhood. Although multidisciplinary care including surgery, chemotherapy and radiotherapy have greatly improved the survival rates in WT, there is a scope for further improvement in India and other resource-poor settings. In resource-limited settings, the majority of patients present with large tumors, which may either be unresectable or risky to resect; making preoperative chemotherapy followed by delayed surgery the preferred approach. Histology and staging are used for risk stratification. The imaging procedure of choice is Contrast Enhanced CT scan (CECT) of thorax/ abdomen and pelvis, which is to be done at presentation, as well as for re-evaluation. Surgery is the cornerstone of treatment in WT and Radical Nephroureterectomy and Lymph node sampling is the procedure of choice, to be performed at week 5 in Non Metastatic WT and week 7 in Metastatic WT. WT is an extremely chemosensitive and radiosensitive tumor. Preoperative chemotherapy for Non Metastatic WT consists of 4 wk of Vincristine /Actinomycin and 6 wk of Vincristine /Actinomycin/ Adriamycin for Metastatic WT, with post-operative chemotherapy depending on stage and histology. Radiation therapy is recommended mainly in Stage III and Stage IV WT, with other indications given in the text. Other recommendations, such as treatment of WT in special situations and for supportive care are also detailed in the text.
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Affiliation(s)
- Maya Prasad
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India
| | - Tushar Vora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India.
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Brijesh Arora
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India
| | - Deepak Bansal
- Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gauri Kapoor
- Department of Pediatric Hematology & Oncology, Rajiv Gandhi Cancer Institute & Research Center, Delhi, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India
| | - Venkatraman Radhakrishnan
- Department of Medical Oncology and Pediatric Oncology, Cancer Institute (W.I.A), Adyar, Chennai, India
| | - Tanvir Kaur
- NCD Division, Indian Council of Medical Research (ICMR), New Delhi, India
| | - G K Rath
- Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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18
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Chung EM, Graeber AR, Conran RM. Renal Tumors of Childhood: Radiologic-Pathologic Correlation Part 1. The 1st Decade: From the Radiologic Pathology Archives. Radiographics 2017; 36:499-522. [PMID: 26963460 DOI: 10.1148/rg.2016150230] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Wilms tumor is the second most common pediatric solid tumor and by far the most common renal tumor of infants and young children. As most tumors are large at presentation and are treated with nephrectomy, the role of imaging is primarily in preoperative planning and evaluation for metastatic disease. However, with treatment protocols increasingly involving use of preoperative (neoadjuvant) chemotherapy (the standard in Europe) and consideration of nephron-sparing surgery, the role of imaging is evolving to include providing initial disease staging information and a presumptive diagnosis to guide therapy. Differential diagnostic considerations include lesions that are clinically benign and others that require more intensive therapy than is used to treat Wilms tumor. In part 1 of this article, the unique histologic spectrum of renal neoplasms of infants and young children is reviewed with emphasis on radiologic-pathologic correlation. Part 2 will focus on renal tumors of older children and adolescents.
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Affiliation(s)
- Ellen M Chung
- From the Department of Radiology and Radiological Sciences (E.M.C.), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (A.R.G.), 4301 Jones Bridge Rd, Bethesda, MD 20814; Pediatric Radiology Section, American Institute for Radiologic Pathology, Silver Spring, Md (E.M.C.); and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Adam R Graeber
- From the Department of Radiology and Radiological Sciences (E.M.C.), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (A.R.G.), 4301 Jones Bridge Rd, Bethesda, MD 20814; Pediatric Radiology Section, American Institute for Radiologic Pathology, Silver Spring, Md (E.M.C.); and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
| | - Richard M Conran
- From the Department of Radiology and Radiological Sciences (E.M.C.), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (A.R.G.), 4301 Jones Bridge Rd, Bethesda, MD 20814; Pediatric Radiology Section, American Institute for Radiologic Pathology, Silver Spring, Md (E.M.C.); and Department of Pathology, Eastern Virginia Medical School, Norfolk, Va (R.M.C.)
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Outcome of Nephroblastoma Treatment According to the SIOP-2001 Strategy at a Single Institution in Argentina. J Pediatr Hematol Oncol 2017; 39:50-55. [PMID: 27379530 DOI: 10.1097/mph.0000000000000632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Wilms tumor (WT) is a disease with a good prognosis. The aim of this study was to evaluate the outcome of patients with WT, treated according to the SIOP-2001 strategy. METHODS A retrospective analysis of 141 consecutive patients with WT diagnosed at our institution between December 2001 and 2013 was performed. RESULTS A total of 114 patients, median age 38.8 months (3 to 155 mo), were assessable for analysis. Fine-needle aspiration was initially performed in 88 patients (84.6%). Stage distribution was: I: 33%, II: 9.6%, III: 28%, IV: 14%, V: 14.9%. Six patients were stage III because of tumor spillage. The remaining patients received preoperative chemotherapy. Adjuvant chemotherapy was given without randomization, using vincristine-actinomycin for stage II and vincristine-doxorubicin-actinomycin plus radiotherapy for stage III. After a median follow-up of 52 months, 5-year overall survival and event-free survival were 91% and 85%, respectively. Overall survival according to stage was: I: 96%, II: 99%, III: 88%, IV: 78%, V: 90% (P=0.16). There was no significant difference in event-free survival (P=0.7). Seventy-eight (85.7%) were intermediate-risk and 11 (12%) were high-risk patients. Seventeen patients (14.9%) relapsed within 2 to 99 months (median 29.9 mo). Eight patients (7%) died of progressive disease. There were no treatment-related deaths. CONCLUSIONS The SIOP-01 protocol proposes a treatment strategy that is feasible in our institution, achieving good results.
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Samim A, Littooij AS, van den Heuvel-Eibrink MM, Wessels FJ, Nievelstein RAJ, de Jong PA. Frequency and characteristics of pulmonary nodules in children at computed tomography. Pediatr Radiol 2017; 47:1751-1758. [PMID: 28871322 PMCID: PMC5693979 DOI: 10.1007/s00247-017-3946-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/28/2017] [Accepted: 07/10/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Normative data on pulmonary nodules in children without malignancy are limited. Knowledge of the frequency and characteristics of pulmonary nodules in healthy children can influence care decisions in children with malignant disease. OBJECTIVE To provide normative data concerning the frequency and characteristics of pulmonary nodules on computed tomography (CT) in young children. MATERIALS AND METHODS All children ages 1 year-12 years who underwent chest CT after high-energy trauma were retrospectively investigated. Exclusion criteria were a history of malignancy, thick image slices, motion artefacts and extensive post-traumatic pulmonary changes. Two radiologists were asked to independently identify all nodules and to characterize each nodule with respect to location, size, perifissural location and calcification. Discrepancies were adjudicated by a third reader, who set the reference standard in this study. Interobserver agreement in detection and characterization was assessed using the kappa coefficient (κ). RESULTS Identified were 120 patients, of whom 72 (75% male; median age: 8.0 years [interquartile range: 4-11]) were included. A total of 59 pulmonary nodules were present in 27 patients (38%; 95% confidence interval: 26-49%; range: 1-5 nodules per patient, with a mean diameter of 3.2 mm [standard deviation: 0.9 mm]). For nodule detection, the per-patient interobserver agreement was substantial (κ=0.78) and per-lobe agreement was moderate (κ=0.40). For characterization, there was fair to substantial agreement (κ=0.36-0.74). CONCLUSION Small pulmonary nodules on chest CT are a common finding in otherwise healthy children, but detection and characterization have only moderate interobserver agreement.
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Affiliation(s)
- Atia Samim
- Department of Radiology, University Medical Centre Utrecht/Wilhelmina Children’s Hospital, HP E01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Annemieke S. Littooij
- Department of Radiology, University Medical Centre Utrecht/Wilhelmina Children’s Hospital, HP E01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marry M. van den Heuvel-Eibrink
- Department of Pediatric Oncology, Princess Máxima Centre for Pediatric Oncology, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Frank J. Wessels
- Department of Radiology, University Medical Centre Utrecht/Wilhelmina Children’s Hospital, HP E01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger A. J. Nievelstein
- Department of Radiology, University Medical Centre Utrecht/Wilhelmina Children’s Hospital, HP E01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pim A. de Jong
- Department of Radiology, University Medical Centre Utrecht/Wilhelmina Children’s Hospital, HP E01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Burak Özkan M, Tscheuner S, Ozkan E. Diagnostic accuracy of MIP slice modalities for small pulmonary nodules in paediatric oncology patients revisited: What is additional from the paediatric radiologist approach? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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22
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Brok J, Treger TD, Gooskens SL, van den Heuvel-Eibrink MM, Pritchard-Jones K. Biology and treatment of renal tumours in childhood. Eur J Cancer 2016; 68:179-195. [PMID: 27969569 DOI: 10.1016/j.ejca.2016.09.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 02/08/2023]
Abstract
In Europe, almost 1000 children are diagnosed with a malignant renal tumour each year. The vast majority of cases are nephroblastoma, also known as Wilms' tumour (WT). Most children are treated according to Société Internationale d'Oncologie Pédiatrique Renal Tumour Study Group (SIOP-RTSG) protocols with pre-operative chemotherapy, surgery, and post-operative treatment dependent on stage and histology. Overall survival approaches 90%, but a subgroup of WT, with high-risk histology and/or relapsed disease, still have a much poorer prognosis. Outcome is similarly poor for the rare non-WT, particularly for malignant rhabdoid tumour of the kidney, metastatic clear cell sarcoma of the kidney (CCSK), and metastatic renal cell carcinoma (RCC). Improving outcome and long-term quality of life requires more accurate risk stratification through biological insights. Biomarkers are also needed to signpost potential targeted therapies for high-risk subgroups. Our understanding of Wilms' tumourigenesis is evolving and several signalling pathways, microRNA processing and epigenetics are now known to play pivotal roles. Most rhabdoid tumours display somatic and/or germline mutations in the SMARCB1 gene, whereas CCSK and paediatric RCC reveal a more varied genetic basis, including characteristic translocations. Conducting early-phase trials of targeted therapies is challenging due to the scarcity of patients with refractory or relapsed disease, the rapid progression of relapse and the genetic heterogeneity of the tumours with a low prevalence of individual somatic mutations. A further consideration in improving population survival rates is the geographical variation in outcomes across Europe. This review provides a comprehensive overview of the current biological knowledge of childhood renal tumours alongside the progress achieved through international collaboration. Ongoing collaboration is needed to ensure consistency of outcomes through standardised diagnostics and treatment and incorporation of biomarker research. Together, these objectives constitute the rationale for the forthcoming SIOP-RTSG 'UMBRELLA' study.
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Affiliation(s)
- Jesper Brok
- Cancer Section, University College London, Institute of Child Health, UK; Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark.
| | - Taryn D Treger
- Cancer Section, University College London, Institute of Child Health, UK
| | - Saskia L Gooskens
- Department of Paediatric Oncology, Princess Máxima Center for Pediatric Oncology and University of Utrecht, The Netherlands; Department of Paediatric Haematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Paediatric Oncology, Princess Máxima Center for Pediatric Oncology and University of Utrecht, The Netherlands
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Abstract
Despite an impressive increase in survival rate over the past decades, there is still a need to improve the survival of specific subgroups of Wilms tumor (anaplastic, metastatic, and bilateral) and to decrease the late effects of treatment in terms of renal function and heart toxicity. We aim to explore new areas of improvement, from diagnosis to treatment: in the field of radiology the increased use of MRI and exploration of its diffusion-weighted imaging capabilities to predict WT histology at diagnosis and for preoperative assessment; in biology the emergence of new biomarkers that could be integrated into the decision-making process; and surgical techniques with more accurate indication of nephron-sparing surgery that is no longer reserved for bilateral WT and the minimally invasive approach. The long-term outcome of patients with WT should thus be a strong indicator of the improvement in adapting and personalizing the treatment to each individual.
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Affiliation(s)
- Sabine Irtan
- Department of Pediatric Surgery, APHP Hôpital Armand Trousseau, Research Unit St Antoine Inserm UMRS.938, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Peter F Ehrlich
- Pediatric Surgery Department, C.S. Mott Children׳s Hospital, University of Michigan, Ann Arbor, Michigan
| | - Kathy Pritchard-Jones
- Cancer Section, Developmental Biology & Cancer Programme, Institute of Child Health, University College London, 30 Guilford St, London WC1N 1EH, UK.
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Rais F, Benhmidou N, Rais G, Loughlimi H, Kouhen F, Maghous A, Aarab J, Bellahammou K, Moukinebillah M, Khattab M, Chala S, Elmejjaoui S, Kebdani T, Elkacemi H, Benjaafar N. Wilms tumor in childhood: Single centre retrospective study from the National Institute of Oncology of Rabat and literature review. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2016. [DOI: 10.1016/j.phoj.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Green DM. Considerations in the Diagnosis and Management of Pediatric Patients With Favorable Histology Wilms Tumor Who Present With Only Pulmonary Nodules. Pediatr Blood Cancer 2016; 63:589-92. [PMID: 26626261 PMCID: PMC4755814 DOI: 10.1002/pbc.25840] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/01/2015] [Accepted: 10/18/2015] [Indexed: 11/05/2022]
Abstract
More than 70% of children with stage IV, favorable histology (FH) Wilms tumor will be relapse-free survivors 16 years after diagnosis. Successful treatment generally includes whole lung radiation therapy and doxorubicin. Such therapy is associated with adverse, long-term effects, including impaired pulmonary function, congestive heart failure, and second malignant neoplasms, especially breast cancer. Cooperative groups have adopted a risk-based approach to the treatment of these patients. It is important to recall the good overall prognosis for this group before recommendations for intensification are made based on preliminary data and in the absence of histological confirmation of persistent malignant disease.
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Affiliation(s)
- Daniel M Green
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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Dome JS, Graf N, Geller JI, Fernandez CV, Mullen EA, Spreafico F, Van den Heuvel-Eibrink M, Pritchard-Jones K. Advances in Wilms Tumor Treatment and Biology: Progress Through International Collaboration. J Clin Oncol 2015; 33:2999-3007. [PMID: 26304882 PMCID: PMC4567702 DOI: 10.1200/jco.2015.62.1888] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Clinical trials in Wilms tumor (WT) have resulted in overall survival rates of greater than 90%. This achievement is especially remarkable because improvements in disease-specific survival have occurred concurrently with a reduction of therapy for large patient subgroups. However, the outcomes for certain patient subgroups, including those with unfavorable histologic and molecular features, bilateral disease, and recurrent disease, remain well below the benchmark survival rate of 90%. Therapy for WT has been advanced in part by an increasingly complex risk-stratification system based on patient age; tumor stage, histology, and volume; response to chemotherapy; and loss of heterozygosity at chromosomes 1p and 16q. A consequence of this system has been the apportionment of patients into such small subgroups that only collaboration between large international WT study groups will support clinical trials that are sufficiently powered to answer challenging questions that move the field forward. This article gives an overview of the Children's Oncology Group and International Society of Pediatric Oncology approaches to WT and focuses on four subgroups (stage IV, initially inoperable, bilateral, and relapsed WT) for which international collaboration is pressing. In addition, biologic insights resulting from collaborative laboratory research are discussed. A coordinated expansion of international collaboration in both clinical trials and laboratory science will provide real opportunity to improve the treatment and outcomes for children with renal tumors on a global level.
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Affiliation(s)
- Jeffrey S Dome
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom.
| | - Norbert Graf
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - James I Geller
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - Conrad V Fernandez
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - Elizabeth A Mullen
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - Filippo Spreafico
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - Marry Van den Heuvel-Eibrink
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - Kathy Pritchard-Jones
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
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Dumba M, Jawad N, McHugh K. Neuroblastoma and nephroblastoma: a radiological review. Cancer Imaging 2015; 15:5. [PMID: 25889326 PMCID: PMC4446071 DOI: 10.1186/s40644-015-0040-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/09/2015] [Indexed: 12/22/2022] Open
Abstract
Neuroblastoma (NBL) is the most common extra-cranial tumour in childhood. It can present as an abdominal mass, but is usually metastatic at diagnosis so the symptomatology can be varied. Nephroblastoma, also more commonly known as a Wilms tumour, is the commonest renal tumour in childhood and more typically presents as abdominal pathology with few constitutional symptoms, although rarely haematuria can be a presenting feature. The pathophysiology and clinical aspects of both tumours including associated risk factors and pathologies are discussed. Oncogenetics and chromosomal abnormalities are increasingly recognised as important prognostic indicators and their impact on initial management is considered. Imaging plays a pivotal role in terms of diagnosis and recent imaging advances mean that radiology has an increasingly crucial role in the management pathway. The use of image defined risk factors in neuroblastoma has begun to dramatically change how this tumour is characterised pre-operatively. The National Wilms Tumour Study Group have comprehensively staged Wilms tumours and this is reviewed as it impacts significantly on management. The use of contrast-enhanced MRI and diffusion-weighted sequences have further served to augment the information available to the clinical team during initial assessment of both neuroblastomas and Wilms tumours. The differences in management strategies are outlined. This paper therefore aims to provide a comprehensive update on these two common paediatric tumours with a particular emphasis on the current crucial role played by imaging.
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Affiliation(s)
- Maureen Dumba
- Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Noorulhuda Jawad
- Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
| | - Kieran McHugh
- Department of Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
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Abstract
This article questions the scientific justification of ingrained radiologic practices exemplified by size measurements of childhood solid tumours. This is approached by a critical review of staging systems from a selection of paediatric oncological treatment protocols. Local staging remains size-dependent for some tumour types. The consequent stage assignment can significantly influence treatment intensity. Still, the protocols tend not to give precise guidance on how to perform scans and standardise measurements. Also, they do not estimate or account for the inevitable variability in measurements. Counts and measurements of lung nodules are, within some tumour groups, used for diagnosis of metastatic disease. There is, however, no evidence that nodule size is a useful discriminator of benign and malignant lung nodules. The efficacy of imaging depends chiefly on observations being precise, accurate and valid for the desired diagnostic purpose. Because measurements without estimates of their errors are meaningless, studies of variability dependent on tumour shape and location, imaging device and observer need to be encouraged. Reproducible observations make good candidates for staging parameters if they have prognostic validity and at the same time show little covariation with (thereby adding new information to) the existing staging system. The lack of scientific rigour has made the validity of size measurement very difficult to assess. Action is needed, the most important being radiologists' active contribution in development of oncological staging systems, attention to standardisation, knowledge about errors in measurement and protection against undue influence of such errors in the staging of the individual child.
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Maschietto M, Williams RD, Chagtai T, Popov SD, Sebire NJ, Vujanic G, Perlman E, Anderson JR, Grundy P, Dome JS, Pritchard-Jones K. TP53 mutational status is a potential marker for risk stratification in Wilms tumour with diffuse anaplasia. PLoS One 2014; 9:e109924. [PMID: 25313908 PMCID: PMC4196953 DOI: 10.1371/journal.pone.0109924] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/04/2014] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The presence of diffuse anaplasia in Wilms tumours (DAWT) is associated with TP53 mutations and poor outcome. As patients receive intensified treatment, we sought to identify whether TP53 mutational status confers additional prognostic information. PATIENTS AND METHODS We studied 40 patients with DAWT with anaplasia in the tissue from which DNA was extracted and analysed for TP53 mutations and 17p loss. The majority of cases were profiled by copy number (n = 32) and gene expression (n = 36) arrays. TP53 mutational status was correlated with patient event-free and overall survival, genomic copy number instability and gene expression profiling. RESULTS From the 40 cases, 22 (55%) had TP53 mutations (2 detected only after deep-sequencing), 20 of which also had 17p loss (91%); 18 (45%) cases had no detectable mutation but three had 17p loss. Tumours with TP53 mutations and/or 17p loss (n = 25) had an increased risk of recurrence as a first event (p = 0.03, hazard ratio (HR), 3.89; 95% confidence interval (CI), 1.26-16.0) and death (p = 0.04, HR, 4.95; 95% CI, 1.36-31.7) compared to tumours lacking TP53 abnormalities. DAWT carrying TP53 mutations showed increased copy number alterations compared to those with wild-type, suggesting a more unstable genome (p = 0.03). These tumours showed deregulation of genes associated with cell cycle and DNA repair biological processes. CONCLUSION This study provides evidence that TP53 mutational analysis improves risk stratification in DAWT. This requires validation in an independent cohort before clinical use as a biomarker.
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Affiliation(s)
- Mariana Maschietto
- Cancer Section, Institute of Child Health, University College London, London, United Kingdom
| | - Richard D. Williams
- Cancer Section, Institute of Child Health, University College London, London, United Kingdom
| | - Tasnim Chagtai
- Cancer Section, Institute of Child Health, University College London, London, United Kingdom
| | - Sergey D. Popov
- Divisions of Molecular Pathology and Cancer Therapeutics, Institute of Cancer Research, London, United Kingdom
| | - Neil J. Sebire
- Departments of Histopathology, Great Ormond Street Hospital, London, United Kingdom
| | - Gordan Vujanic
- Department of Pathology, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Elizabeth Perlman
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, United States of America
| | - James R. Anderson
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Paul Grundy
- Departments of Pediatrics and of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey S. Dome
- Division of Pediatric Hematology/Oncology, Children's National Medical Center, Washington, District of Columbia, United States of America
| | - Kathy Pritchard-Jones
- Cancer Section, Institute of Child Health, University College London, London, United Kingdom
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Segers H, van den Heuvel-Eibrink MM, Williams RD, van Tinteren H, Vujanic G, Pieters R, Pritchard-Jones K, Bown N. Gain of 1q is a marker of poor prognosis in Wilms' tumors. Genes Chromosomes Cancer 2013; 52:1065-74. [PMID: 24038759 DOI: 10.1002/gcc.22101] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/22/2013] [Indexed: 12/31/2022] Open
Abstract
Wilms' tumor (WT) trials aim to better tailor treatment intensity to the risk of relapse and death. Currently, stage, histology, age (< or > 24 months), and combined loss of heterozygosity at 1p and 16q in chemotherapy-naïve WTs are the only risk factors used for treatment stratification. However, they predict only less than one-third of all relapsing patients, implying that other factors are involved in treatment failure. Previous studies have associated 1q gain with adverse outcome. Therefore, in this study, the role of 1q gain and other common cytogenetic aberrations (CAs) in WTs was investigated and related to follow-up data from patients with WT treated in the United Kingdom; 19% (64/331) had 1q gain. Gain of 1q was significantly associated with 16q loss (P < 0.001) and 1p loss (P < 0.001). In multivariate analysis taking account of age, tumor stage, anaplasia, and common CA (e.g., 1p loss and 16q loss), 1q gain was independently associated with adverse event-free survival [EFS; hazard ratio (HR) = 2.45, P = 0.02] and overall survival (HR = 4.28, P = 0.004). Loss of 14q was independently associated with an adverse EFS (HR = 4.0, P = 0.04). Gain of 1q is a marker of poor prognosis in WTs, independent of high tumor stage and anaplasia which remain the overarching adverse prognostic factors. Confirmation in other studies is necessary before future therapeutic studies can incorporate 1q gain into new risk stratification schema.
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Affiliation(s)
- H Segers
- Department of Pediatric Oncology/Hematology, Erasmus MC, Sophia Children's Hospital, Rotterdam, 3015, GJ, The Netherlands
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Kilburn-Toppin F, Arthurs OJ, Tasker AD, Set PAK. Detection of pulmonary nodules at paediatric CT: maximum intensity projections and axial source images are complementary. Pediatr Radiol 2013; 43:820-6. [PMID: 23344916 DOI: 10.1007/s00247-012-2597-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 11/13/2012] [Accepted: 11/13/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maximum intensity projection (MIP) images might be useful in helping to differentiate small pulmonary nodules from adjacent vessels on thoracic multidetector CT (MDCT). OBJECTIVE The aim was to evaluate the benefits of axial MIP images over axial source images for the paediatric chest in an interobserver variability study. MATERIALS AND METHODS We included 46 children with extra-pulmonary solid organ malignancy who had undergone thoracic MDCT. Three radiologists independently read 2-mm axial and 10-mm MIP image datasets, recording the number of nodules, size and location, overall time taken and confidence. RESULTS There were 83 nodules (249 total reads among three readers) in 46 children (mean age 10.4 ± 4.98 years, range 0.3-15.9 years; 24 boys). Consensus read was used as the reference standard. Overall, three readers recorded significantly more nodules on MIP images (228 vs. 174; P < 0.05), improving sensitivity from 67% to 77.5% (P < 0.05) but with lower positive predictive value (96% vs. 85%, P < 0.005). MIP images took significantly less time to read (71.6 ± 43.7 s vs. 92.9 ± 48.7 s; P < 0.005) but did not improve confidence levels. CONCLUSION Using 10-mm axial MIP images for nodule detection in the paediatric chest enhances diagnostic performance, improving sensitivity and reducing reading time when compared with conventional axial thin-slice images. Axial MIP and axial source images are complementary in thoracic nodule detection.
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Affiliation(s)
- Fleur Kilburn-Toppin
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, Box 219, Hills Road, Cambridge, CB2 0QQ, UK.
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Grundy PE, Green DM, Dirks AC, Berendt AE, Breslow NE, Anderson JR, Dome JS. Clinical significance of pulmonary nodules detected by CT and Not CXR in patients treated for favorable histology Wilms tumor on national Wilms tumor studies-4 and -5: a report from the Children's Oncology Group. Pediatr Blood Cancer 2012; 59:631-5. [PMID: 22422736 PMCID: PMC3397278 DOI: 10.1002/pbc.24123] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 02/08/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Metastatic lung disease in Wilms tumor (WT) patients was traditionally identified by chest radiograph (CXR). It is unclear whether patients with small lesions, detectable only by computed tomography ("CT-only" lesions), require the more intensive therapy, including doxorubicin and lung irradiation, given to patients with metastases detectable by CXR. PROCEDURES This study involved 417 patients with favorable histology WT and isolated lung metastases (detected by CXR or CT) who were registered on National Wilms tumor Study (NWTS)-4 or -5. Outcomes by method of detection (CXR vs. CT-only), use of lung radiation, and 2- or 3-drug chemotherapy (dactinomycin and vincristine ± doxorubicin) were determined and compared using the log-rank test. RESULTS There were 231 patients with lung lesions detected by CXR and 186 by CT-only. Of the patients with CT-only nodules, 37 received only 2 drugs and 101 did not receive lung radiation. Five-year event-free survival (EFS) was greater for patients receiving three drugs (including doxorubicin) with or without lung radiation than for those receiving two drugs (80% vs. 56%; P = 0.004). There was no difference seen in 5-year overall survival (OS) between the 3- and 2-drug subsets (87% vs. 86%; P = 0.91). There were no significant differences in EFS (82% vs. 72%; P = 0.13) or OS (91% vs. 83%; P = 0.46) for patients with CT-only nodules whether they received lung radiation or not. CONCLUSIONS Our results suggest that patients with CT-only lung lesions may have improved EFS but not OS from the addition of doxorubicin but do not appear to benefit from pulmonary radiation.
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Affiliation(s)
- Paul E. Grundy
- Departments of Pediatrics and Oncology, University of Alberta, Edmonton Canada
| | - Daniel M. Green
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | - Astrid C. Dirks
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, European Graduate School of Neuroscience, Maastricht, The Netherlands
| | | | - Norman E. Breslow
- University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA
| | - James R. Anderson
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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