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Autologous Stem Cell Transplantation for Children With Renal Tumors, and Adults With Wilms Tumor: Retrospective Analysis of the Japanese Transplant Registry Unified Management Program. J Pediatr Hematol Oncol 2020; 42:251-255. [PMID: 32134841 DOI: 10.1097/mph.0000000000001779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Almost all pediatric patients with renal tumors are diagnosed with nephroblastoma (Wilms tumor), clear cell sarcoma, or malignant rhabdoid tumor. The choice of treatment is important for relapsed and refractory patients with nephroblastoma. Furthermore, clear cell sarcoma of the kidney (CCSK) and malignant rhabdoid tumor of the kidney (MRTK) have a poor prognosis compared with nephroblastoma. Thus, stem cell transplantation (SCT) is sometimes selected to treat these tumors. PATIENTS AND METHODS The authors targeted a total of 84 patients with nephroblastoma, CCSK, and MRTK who underwent a first autologous SCT between 1992 and 2014, and were registered in the Japanese Transplant Registry Unified Management Program system. The authors retrospectively analyzed the SCT data for survival rate. RESULTS Five-year overall survival rates for nephroblastoma, CCSK, and MRTK were 72.4%±6.3%, 46.8%±13.8%, and 36.4%±14.5%, respectively. The event-free survival rates at 5 years were 64.9%±6.7%, 35.7%±12.8%, and 27.3%±13.4%, respectively. The relapse rates at 5 years were 25.3%±11.4%, 46.2%±28.4%, and 60.0%±43.1%, respectively. CONCLUSION Although the survival rate for nephroblastoma was relatively high, those of CCSK and MRTK were poor.
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Rossoff J, Tse WT, Duerst RE, Schneiderman J, Morgan E, Kletzel M, Chaudhury S. High-dose chemotherapy and autologous hematopoietic stem-cell rescue for treatment of relapsed and refractory Wilms tumor: Re-evaluating outcomes. Pediatr Hematol Oncol 2018; 35:316-321. [PMID: 30681039 DOI: 10.1080/08880018.2018.1532478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Wilms tumor (WT) treatment regimens are curative for more than 80% of patients, but those with relapsed or refractory disease continue to have poor outcomes. High-dose chemotherapy followed by autologous stem cell rescue is often utilized although outcomes remain variable. We report on HD-ASCR outcomes in 24 patients with relapsed or refractory Wilms tumor. Three-year disease free and overall survival are 46% and 60%, respectively, which is similar to those reported for conventional salvage therapies. These outcomes suggest that conventional salvage therapies should be employed for relapsed and refractory WT rather than HD-ASCR.
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Affiliation(s)
- Jenna Rossoff
- a Division of Hematology, Department of Pediatrics, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine , Northwestern University , Chicago , Illinois , USA
| | - William T Tse
- a Division of Hematology, Department of Pediatrics, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine , Northwestern University , Chicago , Illinois , USA
| | - Reggie E Duerst
- a Division of Hematology, Department of Pediatrics, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine , Northwestern University , Chicago , Illinois , USA
| | - Jennifer Schneiderman
- a Division of Hematology, Department of Pediatrics, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine , Northwestern University , Chicago , Illinois , USA
| | - Elaine Morgan
- a Division of Hematology, Department of Pediatrics, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine , Northwestern University , Chicago , Illinois , USA
| | - Morris Kletzel
- a Division of Hematology, Department of Pediatrics, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine , Northwestern University , Chicago , Illinois , USA
| | - Sonali Chaudhury
- a Division of Hematology, Department of Pediatrics, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine , Northwestern University , Chicago , Illinois , USA
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Gooskens SL, Graf N, Furtwängler R, Spreafico F, Bergeron C, Ramírez-Villar GL, Godzinski J, Rübe C, Janssens GO, Vujanic GM, Leuschner I, Coulomb-L'Hermine A, Smets AM, de Camargo B, Stoneham S, van Tinteren H, Pritchard-Jones K, van den Heuvel-Eibrink MM. Position paper: Rationale for the treatment of children with CCSK in the UMBRELLA SIOP-RTSG 2016 protocol. Nat Rev Urol 2018; 15:309-319. [PMID: 29485128 DOI: 10.1038/nrurol.2018.14] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The International Society of Paediatric Oncology-Renal Tumour Study Group (SIOP-RTSG) has developed a new protocol for the diagnosis, treatment, and follow-up monitoring of childhood renal tumours - the UMBRELLA SIOP-RTSG 2016 protocol (the UMBRELLA protocol). This protocol has been designed to continue international collaboration in the treatment of childhood renal tumours and will be implemented in over 50 different countries. Clear cell sarcoma of the kidney, which is a rare paediatric renal tumour that most commonly occurs in children between 2 and 4 years of age, is specifically addressed in the UMBRELLA protocol.
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Affiliation(s)
- Saskia L Gooskens
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands.,Department of Paediatric Haematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Norbert Graf
- Department of Paediatric Haematology and Oncology, Saarland University, Homburg, Germany
| | - Rhoikos Furtwängler
- Department of Paediatric Haematology and Oncology, Saarland University, Homburg, Germany
| | - Filippo Spreafico
- Department of Haematology and Paediatric Onco-Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Gema L Ramírez-Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Jan Godzinski
- Department of Emergency Medicine, Medical University of Wroclaw and Department of Paediatric Surgery, Marciniak Hospital, Wroclaw, Poland
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University, Homburg, Germany
| | - Geert O Janssens
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands.,Department of Radiation Oncology, Utrecht University Medical Center, Utrecht, Netherlands
| | - Gordan M Vujanic
- Department of Pathology, Sidra Medicine, Sidra Hospital, Qatar Foundation, Doha, Qatar
| | - Ivo Leuschner
- Kiel Paediatric Tumour Registry, Department of Paediatric Pathology, University Schleswig-Holstein, Kiel, Germany
| | - Aurore Coulomb-L'Hermine
- Department of Pathology, Hopitaux Universitaires Est Parisien, Trousseau La Roche-Guyon, Paris, France
| | - Anne M Smets
- Department of Radiology, Academic Medical Center (AMC), Amsterdam, Netherlands
| | - Beatriz de Camargo
- Instituto Nacional do Cancer, Paediatric Haematology and Oncology Program, Rio de Janeiro, Brazil
| | - Sara Stoneham
- Department of Paediatric and Adolescent Oncology, University College Hospital, Bloomsbury, London, UK
| | - Harm van Tinteren
- Department of Statistics, Netherlands Cancer Institute (NKI-AvL), Amsterdam, Netherlands
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College, London, UK
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Gooskens SL, Furtwängler R, Spreafico F, van Tinteren H, de Kraker J, Vujanic GM, Leuschner I, Coulomb-L'Herminé A, Godzinski J, Schleiermacher G, Stoneham S, Bergeron C, Pritchard-Jones K, Graf N, van den Heuvel-Eibrink MM. Treatment and outcome of patients with relapsed clear cell sarcoma of the kidney: a combined SIOP and AIEOP study. Br J Cancer 2014; 111:227-33. [PMID: 24937667 PMCID: PMC4102945 DOI: 10.1038/bjc.2014.291] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/17/2014] [Accepted: 05/07/2014] [Indexed: 11/09/2022] Open
Abstract
Background: Clear cell sarcoma of the kidney (CCSK) is an uncommon paediatric renal tumour. Relapses occur in about 15% of the patients. Since detailed clinical information on relapsed CCSK is scarce, the current study aims to describe outcome of patients with relapsed CCSK treated according to recent European protocols. Patients and methods: We analysed prospectively collected data of all CCSK patients who developed a relapse after complete remission at the end of primary treatment, entered onto SIOP and AIEOP trials between 1992 and 2012. Results: Thirty-seven of 237 CCSK patients (16%) treated according to SIOP and AIEOP protocols developed a relapse. Median time from initial diagnosis to relapse was 17 months (range, 5.5 months - 6.6 years). Thirt-five out of thirty-seven relapses (95%) were metastatic; the most common sites of relapse were the brain (n=13), lungs (n=7) and bone (n=5). Relapse treatment consisted of chemotherapy (n=30), surgery (n=19) and/or radiotherapy (n=18), followed by high-dose chemotherapy and autologous bone marrow transplantation (ABMT) in 14 patients. Twenty-two out of thirty-seven patients (59%) achieved a second complete remission (CR); 15 of whom (68%) developed a second relapse. Five-year event-free survival (EFS) after relapse was 18% (95% CI: 4%–32%), and 5-year overall survival (OS) was 26% (95% CI: 10%–42%). Conclusions: In this largest series of relapsed CCSK patients ever described, overall outcome is poor. Most relapses are metastatic and brain relapses are more common than previously recognised. Intensive treatment aiming for local control, followed by high dose chemotherapy and ABMT, seems to be of benefit to enhance survival. Novel development of targeted therapy is urgently required.
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Affiliation(s)
- S L Gooskens
- Department of Paediatric Haematology and Oncology, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015GJ Rotterdam, The Netherlands
| | - R Furtwängler
- Department of Paediatric Haematology and Oncology, Saarland University, Campus, 66123 Saarbrücken, Germany
| | - F Spreafico
- Paediatric Oncology Unit, Department of Haematology and Paediatric Onco-Haematology, Fondazione IRCCS Instituto Nazionale dei Tumori, Via Giacomo Venezian,1, 20133 Milano, Italy
| | - H van Tinteren
- Department of Statistics, Netherlands Cancer Institute (NKI-AvL), Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - J de Kraker
- Department of Paediatric Haematology and Oncology, Academic Medical Center-Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - G M Vujanic
- Department of Pathology, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - I Leuschner
- Institute of Pathology, University of Kiel, Christian-Albrechts-Platz 4, 24118 Kiel, Germany
| | - A Coulomb-L'Herminé
- Department of Pathology, Hopitaux Universitaires Est Parisien, Trousseau La Roche-Guyon, 26 Avenue du Docteur Arnold Netter, 75012 Paris, France
| | - J Godzinski
- Department of Emergency Medicine, Medical University of Wroclaw, and Department of Paediatric Surgery, Marciniak Hospital, Slezna 96, 53-111 Wroclaw, Poland
| | - G Schleiermacher
- Department of Paediatric Oncology and INSERM U830, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France
| | - S Stoneham
- Department of Paediatric and Adolescent Oncology, University College Hospital, 235 Euston Rd, London NW1 2BU, UK
| | - C Bergeron
- Department of Paediatrics, Centre Lyon Berard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - K Pritchard-Jones
- Molecular Haematology and Cancer Biology, Institute of Child Health, University College, Gower St, London WCE1 6BT, UK
| | - N Graf
- Department of Paediatric Haematology and Oncology, Saarland University, Campus, 66123 Saarbrücken, Germany
| | - M M van den Heuvel-Eibrink
- Department of Paediatric Haematology and Oncology, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015GJ Rotterdam, The Netherlands
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Ha TC, Spreafico F, Graf N, Dallorso S, Dome JS, Malogolowkin M, Furtwängler R, Hale JP, Moroz V, Machin D, Pritchard-Jones K. An international strategy to determine the role of high dose therapy in recurrent Wilms' tumour. Eur J Cancer 2012; 49:194-210. [PMID: 22959164 DOI: 10.1016/j.ejca.2012.07.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 06/28/2012] [Accepted: 07/18/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To review event-free (EFS) and overall survival (OS) from publications describing outcome for children with relapsed Wilms' tumour. Comparisons are made between those receiving myeloablative high dose chemotherapy with autologous stem-cell rescue (HDT) and those not (NoHDT). MATERIALS AND METHODS Relevant information was extracted from individual patient or summary data and 3-year EFS and OS rates established. These rates were combined in a weighted manner to derive hazard ratios (HRs). RESULTS Nineteen publications were identified (5 HDT, 6 NoHDT, 8 both). Pooling all studies suggested an advantage to HDT with a hazard ratio (HR) for EFS of 0.87 (95% confidence interval (CI) 0.67-1.12) and 0.94 (0.71-1.24) for OS. A stratified analysis confined to studies that provided individual patient data on both HDT and NoHDT gave HRs of 0.83 (0.56-1.24) and 0.92 (0.59-1.41). Further, analyses of risk groups, defined by treatment and/or histology prior to first relapse, suggested a HR for EFS of 0.90 (95% CI 0.62-1.31) for those of high and 0.50 (CI 0.31-0.82) for the very high risk patients. CONCLUSION The evidence suggests, although there are many caveats since the information summarised here is not from randomised trials, a great deal of uncertainty concerning the role of HDT in patients following relapse after treatment for their Wilms' tumour. For each risk group we propose a randomised trial comparing a standard with a more intensive therapy with specific choice of regimen tailored to the risk group (and co-operative groups) concerned. A synthesis of updated evidence from studies in this overview together with any emerging studies and future trial information will form the basis for future evidence-based clinical decision-making.
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Affiliation(s)
- Tam C Ha
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore.
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Gooskens SLM, Furtwängler R, Vujanic GM, Dome JS, Graf N, van den Heuvel-Eibrink MM. Clear cell sarcoma of the kidney: a review. Eur J Cancer 2012; 48:2219-26. [PMID: 22579455 DOI: 10.1016/j.ejca.2012.04.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/29/2012] [Accepted: 04/16/2012] [Indexed: 02/07/2023]
Abstract
Clear cell sarcoma of the kidney (CCSK) is a rare renal tumour that is observed most often in children under 3years of age. Only a few large series of CCSK have been reported and patients with CCSK are often included among patients with other types of childhood renal tumours. The purpose of this paper is to review the published series and case reports of CCSK and to create an up-to-date overview of clinical and histological features, genetics, treatment, and outcome.
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Affiliation(s)
- S L M Gooskens
- Department of Pediatric Hematology and Oncology, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands
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Kosmas C, Daladimos T, Athanasopoulos A, Theotikos E, Tsakonas G, Karabelis A, Mylonakis N. Double high-dose chemotherapy and stem cell transplantation in adult Wilms’ tumor. Future Oncol 2010; 6:1803-9. [DOI: 10.2217/fon.10.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
High-dose chemotherapy intensification and hematopoietic stem cell support remains a valuable treatment option for the rare patient with relapsed Wilms’ tumor. We report a 22-year-old adult male with an initially diagnosed stage II Wilms’ tumor, treated by nephrectomy followed by adjuvant chemotherapy. After 1 year, an intra-abdominal relapse was treated with salvage ifosfamide carboplatin etoposide chemotherapy followed by autologous hematopoietic stem cell mobilization. It was intended that he would receive two tandem cycles of high-dose chemotherapy; the first consisting of melphalan etoposide carboplatin; however, the patient did not return to receive the second cycle while in remission, but did return later with grossly relapsed disease. He was then treated with a novel preparative regimen incorporating high-dose topotecan (topotecan, melphalan and cyclophosphamide). This case confirms the feasibility of double high-dose chemotherapy with hematopoietic stem cell support in relapsed Wilms’ tumor. A detailed discussion with an extensive review of the literature, regarding studies evaluating the role and indications of high-dose chemotherapy in Wilms’ tumor is provided.
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Affiliation(s)
| | - Theodoros Daladimos
- Second Division of Medical Oncology, Department of Medicine, ’Metaxa’ Cancer Hospital, Pireaus, Greece Department of Medicine, 2nd Division of Medical Oncology, 51 Botassi Street, 18537 Piraeus, Greece
| | - Aggelos Athanasopoulos
- Blood Transfusion Service Stem Cell Processing Laboratory, ‘Metaxa’ Cancer Hospital, Pireaus, Greece
| | - Evangelos Theotikos
- Second Division of Medical Oncology, Department of Medicine, ’Metaxa’ Cancer Hospital, Pireaus, Greece Department of Medicine, 2nd Division of Medical Oncology, 51 Botassi Street, 18537 Piraeus, Greece
| | - George Tsakonas
- Second Division of Medical Oncology, Department of Medicine, ’Metaxa’ Cancer Hospital, Pireaus, Greece Department of Medicine, 2nd Division of Medical Oncology, 51 Botassi Street, 18537 Piraeus, Greece
| | - Athanasios Karabelis
- Second Division of Medical Oncology, Department of Medicine, ’Metaxa’ Cancer Hospital, Pireaus, Greece Department of Medicine, 2nd Division of Medical Oncology, 51 Botassi Street, 18537 Piraeus, Greece
| | - Nikolaos Mylonakis
- Second Division of Medical Oncology, Department of Medicine, ’Metaxa’ Cancer Hospital, Pireaus, Greece Department of Medicine, 2nd Division of Medical Oncology, 51 Botassi Street, 18537 Piraeus, Greece
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Efficacy of high-dose chemotherapy and autologous stem cell transplant for recurrent Wilms' tumor: a meta-analysis. J Pediatr Hematol Oncol 2010; 32:454-61. [PMID: 20505538 DOI: 10.1097/mph.0b013e3181e001c2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Long-term survival of relapsed Wilms' tumor patients is about 40% to 70%. Modern second-line treatment consists of either (a) salvage chemotherapy+/-radiation therapy (CT) or (b) chemotherapy followed by high-dose chemotherapy and autologous hematopoietic stem cell rescue (ASCR). Here, we conduct an individual patient data meta-analysis on 100 patients collected from 6 studies to determine characteristics that predict survival in relapsed patients who received ASCR therapy. We compare these results with survival data on 118 CT treated patients from 2 recently published studies. Four year overall survival among the combined ASCR treated patients was 54.1% (95% CI: 42.8-64.1%). The ASCR patients who only relapsed in the lungs had higher 4-years survival rates 77.7% (58.6% to 88.8%) than those who relapsed in other locations and/or suffered multiple relapses 41.6% (24.8% to 57.6%). Although lung-only relapse is considered a favorable prognostic factor, there was no clear advantage for the patients treated with salvage chemotherapy. Four-year survival rates among stage I-II patients were about 30% higher with CT than ASCR, but the 2 were comparable for stage III-IV patients. These findings suggest salvage chemotherapy is typically the better choice for relapsed Wilms' tumor patients, ASCR could be considered for stage III-IV patients with a lung-only relapse.
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Radulescu VC, Gerrard M, Moertel C, Grundy PE, Mathias L, Feusner J, Diller L, Dome JS. Treatment of recurrent clear cell sarcoma of the kidney with brain metastasis. Pediatr Blood Cancer 2008; 50:246-9. [PMID: 17226850 DOI: 10.1002/pbc.21131] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Clear cell sarcoma of the kidney (CCSK) is known for its propensity to metastasize to bone, but it also spreads to other sites including the brain. This study was undertaken to describe the treatment and outcomes of patients with recurrent CCSK involving the brain. METHODS A retrospective records review was conducted on eight patients with CCSK who developed brain metastases after complete responses to initial therapy. RESULTS The recurrences occurred at a median of 24.5 months after initial diagnosis (range, 12-53 months). At the time of recurrence, patients were treated with multimodal therapy including biopsy or resection, radiation therapy, and chemotherapy. All patients received a variable number of courses of ifosfamide, carboplatin, and etoposide (ICE), with or without other agents. Four patients received high-dose chemotherapy with autologous stem cell rescue. One patient died from complications of bacteremia 8 weeks after starting chemotherapy. The other seven patients achieved a complete response after either surgery or ICE chemotherapy. Of these, six patients were alive without disease with a median follow-up of 30 months from the time of recurrence (range, 24 to 71 months). All six survivors received radiation therapy and four had gross total resections. Three survivors received high-dose chemotherapy with stem cell rescue. CONCLUSION Patients with recurrent CCSK involving the brain can have durable survival after recurrence. ICE chemotherapy, together with radiation therapy and surgery, provides a reasonable salvage regimen for recurrent CCSK. It is unclear whether high-dose chemotherapy confers a benefit compared to conventional-dose chemotherapy.
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Valera ET, Cristófani L, Scrideli CA, Duarte RJ, Filho VO, Tone LG. Megatherapy in the treatment of high-risk relapsed Wilms tumor. Pediatr Blood Cancer 2004; 43:186-8. [PMID: 15236294 DOI: 10.1002/pbc.20076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elvis Terci Valera
- University Hospital, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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