Tobin R L, Fontanesi J, Kun L E, Fairclough D L, Hustu H O, Pao W J, Douglass E C, Wilimas J, Kumar A P, Jenkins J J
Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN.
Int J Radiat Oncol Biol Phys. 1990 Oct;19(4):867-71. doi: 10.1016/0360-3016(90)90006-6.
Fifty-two children with favorable histology Wilms' tumor who had residual abdominal disease (Surgical Stages III and IV) were treated from 1979 to 1988 on a protocol designed to assess the effectiveness of reduced radiation doses. All patients received three-agent chemotherapy, beginning within 1 week after surgery. To permit assessment of disease response to initial chemotherapy, radiation therapy was delayed for a median of 28 days after surgery (range, 14-71 days). Total doses of abdominal radiation were limited to 12 Gy, given as 150 cGy daily fractions; 18 patients with Stage IV disease received 12 Gy bilateral pulmonary irradiation. Two year disease-free survival was 85% and 71% for Stage III and IV, respectively (p = .24). Abdominal relapses occurred in 3 cases (5.7%). The interval between surgery and initiation of irradiation was not related to disease-free survival. Of several patient and disease-related factors analyzed, only patient age was related to outcome. Disease-free survival was 100% at 3 years for children under the age of 3 versus 78% for children greater than age 3 (p = .05). Reduced-dose abdominal radiotherapy in conjunction with multi-agent chemotherapy and surgery provided excellent disease control with minimal toxicity in advanced-stage, favorable histology Wilms' tumor.
1979年至1988年期间，对52例组织学类型良好且存在腹部残留病灶（手术分期为III期和IV期）的肾母细胞瘤患儿，按照一项旨在评估降低放疗剂量有效性的方案进行了治疗。所有患者均接受三联化疗，于术后1周内开始。为了评估疾病对初始化疗的反应，放疗在术后中位延迟28天进行（范围为14 - 71天）。腹部放疗总剂量限制在12 Gy，每日分次给予150 cGy；18例IV期疾病患者接受了12 Gy的双侧肺部照射。III期和IV期患者的两年无病生存率分别为85%和71%（p = 0.24）。发生腹部复发3例（5.7%）。手术与开始放疗之间的间隔与无病生存率无关。在分析的几个患者和疾病相关因素中，只有患者年龄与预后相关。3岁以下儿童3年无病生存率为100%，而3岁以上儿童为78%（p = 0.05）。在晚期组织学类型良好的肾母细胞瘤中，低剂量腹部放疗联合多药化疗和手术可提供良好的疾病控制，且毒性最小。
