Prognostic factors in nonmetastatic, favorable histology Wilms' tumor: results of the Third National Wilms' Tumor Study

Article Abstract:

Modern combination chemotherapy is quite effective against Wilms' tumor with favorable histology. Wilms' tumor is a kidney cancer that develops from embryonic kidney cells; it is more common among children, but also affects adults. Favorable histology is a phrase used by pathologists to describe an appearance of the tumor under the microscope that suggests a less aggressive tumor. The survival rate from Wilms' tumor with favorable histology is 96 percent after four years for patients with early Stage I disease at the time of diagnosis. The survival of patients with Stage II disease is about 92 percent after four years, but survival drops to 86 percent for those with more advanced Stage III disease. While it is clear from these figures that the survival rate of patients with Wilms' tumor with favorable histology is good, it is also clear that a fraction of patients with the most favorable disease characteristics die. As a part of the Third National Wilms' Tumor Study, cases were reviewed to determine if any features might be found that distinguish the patients who are likely to do poorly from other patients. The most important prognostic factors appeared to be the age of the patient and the size of the tumor. Older patients were more likely to suffer relapse and death. Even among tumors classified as the same stage, the larger tumors were more likely to relapse than the smaller tumors. It was found that in Stage I disease, the size of the tumor was the most important prognostic indicator, while age seemed to exert a greater influence on survival for the patients with Stage II or Stage II disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Histology, Pathological, Pathological histology

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Results of two radiation therapy randomizations in the Third National Wilms' Tumor Study

Article Abstract:

Wilms' tumor is a childhood cancer affecting the kidneys. Several major studies, dubbed the National Wilms' Tumor Studies, have been organized to determine the best methods for treating this disorder. The first and second National Wilms' Tumor Studies, NWTS-1 and NWTS-2, demonstrated that radiation therapy is not necessary for patients with Stage I Wilms' tumor if chemotherapy is administered. (These results only apply to Wilms' tumor with 'favorable histology', that is, having less malignant appearance upon microscopic examination.) Clinicians were anxious to learn if these same results might apply to children with Stage II Wilms' tumor. In Stage II Wilms' tumor, the cancer is extended outside the kidney, but can be completely removed by surgery. In Stage III Wilms' tumor, the surgeon must leave some cancerous tissue behind. In the third National Wilms' tumor study, comparisons were made between chemotherapy alone and chemotherapy combined with radiotherapy. Furthermore, the combination chemotherapy protocol was evaluated with and without the chemotherapeutic drug doxorubicin. The overall two-year disease-free survival was 90 percent for the patients with Stage II disease and 80 percent for the patients with Stage III disease. The use of radiotherapy or the addition of doxorubicin had no statistically significant effect on the survival for Stage II patients. For Stage III patients, the addition of radiotherapy or doxorubicin to the chemotherapeutic regimen was necessary to achieve the full benefit of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Radiotherapy, Chemotherapy, Combination, Combination chemotherapy

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