Retrospective analysis of toxicities and clinical efficacy of postoperative radiotherapy for pediatric nephroblastoma
Lu Ningning, Yu Zihao, Wang Shulian, Yang Yong, Tang Yu, Tang Yuan, Song Yongwen, Jin Jing, Fang Hui, Liu Yueping, Li Ning, Ren Hua, Chen Bo, Qi Shunan, Jing Hao, Li Yexiong
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Abstract：Objective To evaluate the toxicities and clinical efficacy of postoperative radiotherapy for children with nephroblastoma (Wilms’ tumor). Methods In total, 116 WT Children (≤14-year-old) treated with radiotherapy (RT) in our center from 2005 to 2018 were recruited in this retrospective analysis. RT-induced toxicities and clinical efficacy were analyzed. RT was performed guided by Children's Oncology Group (COG) protocol. The overall survival (OS), flank-field control (LC), abdominal control (AC), and distant metastasis-free survival (DMFS) were calculated using the Kaplan-Meiermethod. pathologically proved. Results From January, 2005 to August, 2018, 116 pathologically proved WT patients were enrolled. Most of them were diagnosed with favorable WT (94.8%) and stage Ⅲ WT (87.1%). With a median follow-up time of 30.4(0.7-185.7) months, the 3-year OS, LC, AC and DMFS were 83.9%, 78.2%,75.2% and 82.8%, respectively. Sixty-four (55.2%) patients suffered from Grade I to Ⅱ gastrointestinal toxicities and Grade I to IV hematological toxicities. Only 5 patients (4.3%) had Grade Ⅱ late toxicities. For 96 patients who received adjuvant RT, the median surgery-RT interval time was 1.2(0.5 to 7.1) months. The 3-year OS, LC, AC and DMFS were 88.1%, 96.7%, 92.7% and 86.9%, respectively. Patients with tumor rupture without whole abdomen irradiation (WAI) tended to have lower AC, DMFS and OS.Twenty children received salvage RT when they had disease relapse. The 3-year OS and DMFS of patients with salvage RT were significantly worse than those receiving adjuvant RT (OS:68.2% vs. 88%, P=0.012;DMFS:64.3% vs. 86.9%, P=0.032). Conclusions Tumor bed irradiation for WT patients as per COG protocol can be well tolerated and achieve high efficacy. Salvage RT yields poor efficacy for tumor bed recurrence. Furthermore, tumor rupture without WAI possibly increases the abdominal and distant recurrence and the risk of death.
Lu Ningning,Yu Zihao,Wang Shulian et al. Retrospective analysis of toxicities and clinical efficacy of postoperative radiotherapy for pediatric nephroblastoma[J]. Chinese Journal of Radiation Oncology, 2020, 29(12): 1037-1042.
[1] Irtan S, Ehrlich PF, Pritchard-Jones K. Wilms tumor:"State-of-the-art" update[J]. Semin Pediatr Surg, 2016, 25(5):250-256. DOI:10.1053/j.sempedsurg.2016.09.003. [2] D'Angio GJ, Beckwith JB, Bishop HC, et al. Proceedings:The national Wilms’ tumor study:a progress report[J]. Proc Natl Cancer Conf, 1972, 7:627-636. [3] D'Angio GJ, Evans A, Breslow N, et al. The treatment of Wilms’ tumor:results of the second national Wilms’ tumor study[J]. Cancer, 1981, 47:2302-2311. DOI:10.1002/1097-0142(19810501)47:9<2302::AID-CNCR2820470933>3.0. CO;2-K. [4] Dome JS, Fernandez CV, Mullen EA, et al. Children's Oncology Group's 2013 blueprint for research:renal tumors[J]. Pediatr Blood Cancer, 2013, 60(6):994-1000. DOI:10.1002/pbc.24419. [5] Kalapurakal JA, Li SM, Breslow NE, et al. Influence of radiation therapy delay on abdominal tumor recurrence in patients with favorable histology Wilms’ tumor treated on NWTS-3 and NWTS-4:a report from the National Wilms’ Tumor Study Group[J]. Int J Radiat Oncol Biol Phys, 2003, 57(2):495-499. DOI:10.1016/S0360-3016(03)00598-4. [6] Fernandez CV, Mullen EA, Chi YY, et al. Outcome and prognostic factors in stage Ⅲ favorable-histology wilms tumor:a report from the children's oncology group study AREN0532[J]. J Clin Oncol, 2018, 36(3):254-261. DOI:10.1200/JCO.2017.73.7999. [7] Grundy PE, Breslow NE, Li S, et al. Loss of heterozygosity for chromosomes 1p and 16q is an adverse prognostic factor in favorable-histology Wilms tumor:a report from the National Wilms Tumor Study Group[J]. J Clin Oncol, 2005, 23(29):7312-7321. DOI:10.1200/JCO.2005.01.2799. [8] Stokes CL, Stokes WA, Kalapurakal JA, et al. Timing of radiation therapy in pediatric Wilms tumor:a report from the national cancer database[J]. Int J Radiat Oncol Biol Phys, 2018, 101(2):453-461. DOI:10.1016/j.ijrobp.2018.01.110. [9] Dome JS, Graf N, Geller JI, et al. Advances in wilms tumor treatment and biology:progress through international collaboration[J]. J Clin Oncol, 2015, 33(27):2999-3007. DOI:10.1200/JCO.2015.62.1888. [10] 中国抗癌协会小儿肿瘤专业委员会. 儿童肾母细胞瘤诊断治疗建议(CCCG-WT-2016)[J]. 中华儿科杂志,2017,55(2):90-94. DOI:10.3760/cma.j.issn.0578-1310.2017.02.007. Pediatric Oncology Committee, Chinese Anti-cancer Association. Diagnostic and treatment guidelines for children with nephroblastoma (CCCG-WT-2016)[J]. Chin J Pediatr, 2017, 55(2):90-94. DOI:10.3760/cma.j.issn.0578-1310.2017.02.007. [11] Kalapurakal JA, Li SM, Breslow NE, et al. Intraoperative spillage of favorable histology Wilms tumor cells:Influence of irradiation and chemotherapy regimens on abdominal recurrence. A report from the National Wilms Tumor Study Group[J]. Int J Radiat Oncol Biol Phys, 2010, 76(1):201-206. DOI:10.1016/j.ijrobp.2009.01.046. [12] Brisse HJ, Schleiermacher G, Sarnacki S, et al. Preoperative Wilms tumor rupture:a retrospective study of 57 patients[J]. Cancer, 2008, 113(1):202-213. DOI:10.1002/cncr.23535. [13] Termuhlen AM, Tersak JM, Liu Q, et al. Twenty-five year follow-up of childhood Wilms tumor:a report from the childhood cancer survivor study[J]. Pediatr Blood Cancer, 2011, 57(7):1210-1216. DOI:10.1002/pbc.23090. [14] Van Dijk IWEM, Oldenburger F, Cardous-Ubbink MC, et al. Evaluation of late adverse events in long-term Wilms’ tumor survivors[J]. Int J Radiat Oncol Biol Phys, 2010, 78(2):370-378. DOI:10.1016/j.ijrobp.2009.08.016.
2020, Vol. 29 
