Department of Radiation Oncology, University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
Radiation Oncology Department, Leuven Cancer Center, Leuven, Belgium.
Pediatr Blood Cancer. 2018 Aug;65(8):e27085. doi: 10.1002/pbc.27085. Epub 2018 Apr 25.
To evaluate the value of radiotherapy boost omission in patients with intermediate-risk, stage III Wilms tumours (WT) with positive lymph nodes (LN).
All patients with intermediate-risk, stage III (LN positive) WT consecutively registered in the SIOP-WT-2001 study were included in this analysis. Endpoints were 5-year event-free survival (EFS), loco-regional control (LRC) and overall survival (OS).
Between June 2001 and May 2015, 2,569 patients with stage I to III WT after preoperative chemotherapy were registered in the SIOP-WT-2001 study. Five hundred and twenty-three (20%) had stage III disease, of which 113 patients had stage III due to positive LN only. Of those, 101 (89%) received radiotherapy, 36 of which (36%) received, apart from flank irradiation, a boost dose to the LN positive area. Four patients (4%) did not receive any adjuvant radiotherapy. In eight patients information on radiotherapy was not available. With a median follow-up of 71 months, no difference in 5-year EFS (84% vs. 83%, P = 0.77) and LRC (96% vs. 97%, P = 0.91) was observed between patients receiving a radiotherapy boost and those without boost, respectively. Five-year OS, including salvage therapy, was excellent (boost vs. no boost: 97% vs. 95%, P = 0.58).
Outcome data demonstrate that omission of the radiotherapy boost to the loco-regional positive lymph nodes in patients with intermediate-risk, stage III WT who receive preoperative chemotherapy and postoperative flank irradiation (14.4 Gy) can be considered a safe approach for future SIOP protocols.
评估在伴有阳性淋巴结（LN）的中危 III 期 Wilms 肿瘤（WT）患者中省略放疗增敏的价值。
本研究纳入了连续登记在 SIOP-WT-2001 研究中的所有中危、III 期（LN 阳性）WT 患者。终点为 5 年无事件生存率（EFS）、局部区域控制率（LRC）和总生存率（OS）。
在 2001 年 6 月至 2015 年 5 月期间，共有 2569 例接受术前化疗的 I 期至 III 期 WT 患者登记在 SIOP-WT-2001 研究中。其中 523 例（20%）为 III 期疾病，其中 113 例仅因 LN 阳性而患有 III 期疾病。在这些患者中，101 例（89%）接受了放疗，其中 36 例（36%）除了侧腹照射外，还对 LN 阳性区域进行了增敏剂量照射。4 例（4%）患者未接受任何辅助放疗。在 8 例患者中，放疗信息不可用。中位随访 71 个月后，接受放疗增敏和未接受放疗增敏的患者 5 年 EFS（84% vs. 83%，P=0.77）和 LRC（96% vs. 97%，P=0.91）无差异。包括挽救治疗在内的 5 年 OS 极佳（增敏 vs. 未增敏：97% vs. 95%，P=0.58）。
研究结果表明，对于接受术前化疗和术后侧腹照射（14.4 Gy）的中危 III 期 WT 患者，如果局部区域阳性淋巴结省略放疗增敏，可以考虑作为未来 SIOP 方案的一种安全方法。
