Annals of Oncology 13:944-948, 2002
© 2002 European Society for Medical Oncology
Original Paper |
Treatment of childhood Wilms’ tumor without radiotherapy in Nicaragua
1Manuel de Jaesus Rivera Hospital, La Mascota, Managua, Nicaragua; 2Istituto Nazionale Tumori, Milan, Italy; 3Pediatric Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; 4Department of Oncology, San Giovanni Hospital, Bellinzona, Switzerland
Received 15 June 2001; revised 7 November 2001; accepted 12 December 2001.
Background
Recent trends in therapeutic strategies for Wilms’ tumor are based on an attempt to reduce or omit radiotherapy (RT) in a sizable fraction of patients. We report here the clinical and histological features as well as the results obtained in 37 children (23 males, 14 females; median age at diagnosis 3 years, range 0.8–8 years) diagnosed between 1991 and 1996, and treated with chemotherapy (CT) and surgery at La Mascota Hospital, Managua, Nicaragua.
Patients and methods
Patients were grouped as follows: those who underwent surgery at diagnosis (group A, n = 4), patients who received preoperative CT because of large tumor size (group B, n = 27), lung metastases (n = 5) or bilateral disease (n = 1) (group C, n = 6). Treatment consisted of vincristine (VCR) and actinomycin-D (ACTD) for 24 weeks in group A, and of VCR, ACTD and adriamycin for 68 weeks in groups B and C. Histology was classified as favorable in 30 patients (81%), unfavorable in six patients (all of group B) and unknown in one.
Results
With a median follow-up time of 6.4 years the event-free survival for the whole group was 80.1% ± 6.8 (SE). No event occurred beyond 5 years of diagnosis.
Conclusions
These results suggest that RT does not appear necessary for the majority of patients, and that an excellent surgical approach associated with an intensive CT schedule can control the disease, even in the absence of adequate information on the intra-abdominal tumor extent.
Key words: childhood, low-income countries, therapy, Wilms’ tumor