RT Journal Article
T1 Outcome of SIOP patients with low- or intermediate-risk Wilms tumour relapsing after initial vincristine and actinomycin-D therapy only - the SIOP 93-01 and 2001 protocols.
A1 Groenendijk, Alissa
A1 van Tinteren, Harm
A1 Jiang, Yilin
A1 de Krijger, Ronald R
A1 Vujanic, Gordan M
A1 Godzinski, Jan
A1 Rübe, Christian
A1 Schenk, Jens-Peter
A1 Morosi, Carlo
A1 Pritchard-Jones, Kathy
A1 Al-Saadi, Reem
A1 Vaidya, Sucheta J
A1 Verschuur, Arnauld C
A1 Ramírez-Villar, Gema L
A1 Graf, Norbert
A1 de Camargo, Beatriz
A1 Drost, Jarno
A1 Perotti, Daniela
A1 van den Heuvel-Eibrink, Marry M
A1 Brok, Jesper
A1 Spreafico, Filippo
A1 Mavinkurve-Groothuis, Annelies M C
K1 Recurrence
K1 SIOP protocol
K1 Treatment outcome
K1 Wilms tumour
AB Society of International Pediatric Oncology - Renal Tumor Study Group (SIOP-RTSG) treatment recommendations for relapsed Wilms tumour (WT) are stratified by the intensity of first-line treatment. To explore the evidence for the treatment of patients relapsing after vincristine and actinomycin-D (VA) treatment for primary WT, we retrospectively evaluated rescue treatment and survival of this patient group. We included 109 patients with relapse after VA therapy (no radiotherapy) for stage I-II primary low- or intermediate-risk WT from the SIOP 93-01 and SIOP 2001 studies. Univariate Cox regression analysis was performed to study the effect of relapse treatment intensity on event-free survival (EFS) and overall survival (OS). Relapse treatment intensity was classified into vincristine, actinomycin-D, and either doxorubicin or epirubicin (VAD), and more intensive therapies (ifosfamide/carboplatin/etoposide [ICE]/≥ 4 drugs/high-dose chemotherapy with haematopoietic stem cell transplantation [HD HSCT]). Relapse treatment regimens included either VAD, or cyclophosphamide/carboplatin/etoposide/doxorubicin (CyCED), or ICE backbones. Radiotherapy was administered in 62 patients and HD HSCT in 15 patients. Overall, 5-year EFS and OS after relapse were 72.3% (95% confidence interval [CI]: 64.0-81.6%) and 79.3% (95% CI: 71.5-88.0%), respectively. Patients treated with VAD did not fare worse when compared with patients treated with more intensive therapies (hazard ratio EFS: 0.611 [95% CI: 0.228-1.638] [p-value = 0.327] and hazard ratio OS: 0.438 [95% CI: 0.126-1.700] [p-value = 0.193]). Patients with relapsed WT after initial VA-only treatment showed no inferior EFS and OS when treated with VAD regimens compared with more intensive rescue regimens. A subset of patients relapsing after VA may benefit from less intensive rescue treatment than ICE/CyCED-based regimens and deserve to be pinpointed by identifying additional (molecular) prognostic factors in future studies.
YR 2022
FD 2022-01-15
LK http://hdl.handle.net/10668/22171
UL http://hdl.handle.net/10668/22171
LA en
DS RISalud
RD Apr 10, 2025