Meisel J A, Guthrie K A, Breslow N E, Donaldson S S, Green D M
Department of Radiation Oncology, Stanford University School of Medicine, CA, USA.
Int J Radiat Oncol Biol Phys. 1999 Jun 1;44(3):579-85. doi: 10.1016/s0360-3016(99)00086-3.
To define the optimal treatment for children with Wilms tumor who have pulmonary nodules identified on chest computed tomography (CT) scan, but have a negative chest radiograph, we evaluated the outcome of all such patients randomized or followed on National Wilms Tumor Study (NWTS)-3 and -4.
We estimated the event-free and overall survival percentages of 53 patients with favorable histology tumors and pulmonary densities identified only by CT scan (CT-only) who were treated as Stage IV with intensive doxorubicin-containing chemotherapy and whole-lung irradiation, and compared these to the event-free and overall survival percentages of 37 CT-only patients who were treated less aggressively based on the extent of locoregional disease with 2 or 3 drugs, and without whole-lung irradiation.
The 4-year event-free and overall survival percentages of the 53 patients with CT-only nodules and favorable histology Wilms tumor who were treated as Stage IV were 89% and 91%, respectively. The 4-year event-free and overall survival percentages for the 37 patients with CT-only nodules and favorable histology who were treated according to the extent of locoregional disease were 80% and 85%, respectively. The differences observed between the 2 groups were not statistically significant. Among the patients who received whole-lung irradiation, there were fewer pulmonary relapses, but more deaths attributable to lung toxicity.
The current data raise the possibility that children with Wilms tumor and CT-only pulmonary nodules who receive whole lung irradiation have fewer pulmonary relapses, but a greater number of deaths due to treatment toxicity. The role of whole lung irradiation in the treatment of this group of patients cannot be definitively determined based on the present data. Prolonged follow-up of this group of patients is necessary to accurately estimate the frequency of late, treatment-related mortality.
为确定胸部计算机断层扫描（CT）发现有肺结节但胸部X线片呈阴性的肾母细胞瘤患儿的最佳治疗方案，我们评估了所有在国家肾母细胞瘤研究（NWTS）-3和-4中随机分组或接受随访的此类患者的治疗结果。
我们估算了53例仅通过CT扫描（仅CT）发现有肺密度且组织学类型良好的肿瘤患者的无事件生存率和总生存率，这些患者接受含阿霉素的强化化疗及全肺照射，按IV期治疗，我们将这些结果与37例仅CT患者的无事件生存率和总生存率进行比较，这37例患者根据局部区域疾病范围采用2或3种药物治疗，未进行全肺照射，治疗强度较低。
53例仅CT结节且组织学类型良好的肾母细胞瘤患者按IV期治疗，其4年无事件生存率和总生存率分别为89%和91%。37例仅CT结节且组织学类型良好的患者根据局部区域疾病范围进行治疗，其4年无事件生存率和总生存率分别为80%和85%。两组之间观察到的差异无统计学意义。在接受全肺照射的患者中，肺部复发较少，但因肺毒性导致的死亡较多。
目前的数据提示，接受全肺照射的肾母细胞瘤且仅CT肺结节患儿肺部复发较少，但因治疗毒性导致的死亡较多。基于目前的数据，无法明确确定全肺照射在该组患者治疗中的作用。需要对该组患者进行长期随访，以准确估计晚期治疗相关死亡率的发生频率。
