Journal of Clinical Oncology, 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 22, No 14S (July 15 Supplement), 2004: 8544
© 2004 American Society of Clinical Oncology

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Abstract

Multidisciplinary Approach to Wilms' Tumor: 10 Years Experience of NCI, Egypt

National Cancer Institute, Cairo University, Egypt; Aboul Reish Hospital, Cairo University*, Egypt

8544

Background: This is a retrospective study of 140 nephroblastoma patients newly diagnosed and treated at the National Cancer Institute between January 1991 and December 2000. The aim was to report results of combined modality treatment and to investigate the impact of biopsy, presence of blastema and preoperative chemotherapy on outcome Methods: Chemotherapy consisted of Vincristine 1.5mg/m² and Actinomycin-D 45µg/kg for stage I and stage II favorable. Doxorubicin 40mg/m² was added in alternation with Actinomycin-D to stage II unfavorable and stages III-V. Duration of therapy was 6 months for stage I and stage II favorable, 12 months for stages II unfavorable, III-V favorable and 18 months for stages III-V unfavorable. Rhabdoid tumors were given Etoposide 150mg/m²x3days and Carboplatin 500mg/m² day1 alternating with Ifosfamide 1800mg/m²x5days and Doxorubicin 75mg/m² day1. Postoperative radiotherapy was given to tumor-bed (10–27Gy) in stage II unfavorable, stages III-V and to metastatic lung site (12Gy). Preoperative chemotherapy was employed in massive or bilateral tumors or presence of metastases Results: Using NWTS staging system 21.4%, 36.4%, 20.7%, 15.7% and 5.7% were stages I-V respectively. Histology was favorable (FH) in 93 (67%) patients [31/93 showed blastema] and unfavorable (UH) in 46 (33%). Preoperative chemotherapy resulted in down staging of 30/54 (55.6%) patients to stages I and II, of which only 4 relapsed. Local recurrence was reported in 4/32 patients (12.5%) with core biopsy, 0/15 fine needle biopsy and 10/93 (10.75%) without biopsy. With median follow up of 63 months, overall 5-year survival and disease free survival (DFS) were 72.3±4% and 69±3.9% respectively. For FH, 5-year DFS was 78.2±4.3% [stages I-V being 92%, 74.3%, 74%, 60%, 80%] and 51.4±7.9% for UH (p= .0007, log rank test) [stages I-V being 75%, 72.7%, 63.6%, 8.3%, 33.3%] Within FH, 5-year DFS was 76.6% for blastema versus 83.3% for non blastema (p= .46, log rank) Conclusions: This study suggests that biopsy and down staging after preoperative chemotherapy did not lead to increased risk of recurrence. Presence of blastema had adverse impact on outcome; however it needs to be studied on larger scale

No significant financial relationships to disclose.

Abstract presentation from the 2004 ASCO Annual Meeting