J Korean Med Sci.  2006 Jun;21(3):436-440. 10.3346/jkms.2006.21.3.436.

Improved Survival in Patients with Recurrent Wilms Tumor: the Experience of the Seoul National University Children's Hospital

• Park ES
• Kang HJ
• Shin HY
• Ahn HS

• KMID: 1778424
• DOI: http://doi.org/10.3346/jkms.2006.21.3.436

Abstract

The survival in cases with relapsed Wilms tumor is dismal. Recently, however the introduction of new therapeutic agents and experimental strategies has improved the survival. We analysed the survival of patients with relapsed Wilms tumor according to the treatment period. During the early period 1983-1993, patients who had received two drugs were treated with doxorubicin and the others were treated with cisplatin and etoposide, whereas during the late period 1994-2004, patients were treated with combinations of cyclophosphamide/etoposide and carboplatin/etoposide. During the early period, 8 of 57 experienced relapse, and 8 of 41 relapsed during the late period. Only 2 patients treated during the early period survived in complete response (CR), whereas during the late period, 5 patients remained alive in CR, and 3 of those received high-dose chemotherapy (HDC) with autologous peripheral stem cell rescue (SCR). The estimated 5 yr event-free survival rate was 37.5% in the entire study group, 50% for patients in the late period, and 25% for patients in the early period (p=0.38). The survival in patients with relapsed Wilms tumor dramatically improved during the late period and HDC with SCR was one of the effective salvage strategies.

Keyword

Wilms Tumor; Nephroblastoma; Recurrence; Salvage Therapy; Stem Cells

MeSH Terms

Wilms Tumor/*mortality/*pathology
Treatment Outcome
Time Factors
*Recurrence
*Peripheral Blood Stem Cell Transplantation
Male
Korea
Infant
Humans
Female
Disease-Free Survival
Child, Preschool
Child
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use

Figure

• 

  Fig. 1 Outcome according to the date of relapse. Actinomycin, vincristine and doxorubicin were used pre-1994, and subsequently carboplatin, etoposide and cyclophosphamide were used. From 1994, 4 patients were given high-dose chemotherapy and peripheral stem cell transplantation. All remain alive without event. Two pre-1994 patients and 5 post-1993 patients remain alive, respectively. RL, relapse; CR, complete response; CCR, continuous complete response; RL2, second relapse; NR, no response; AL, alive; Exp, expired.

• 

  Fig. 2 Overall survival (OS, A) and event-free survival (EFS, B) as determined using the Kaplan-Meier method. Estimates of OS were 62.5% and 25% (p=0.38), and EFS were 50% and 25% (p=0.28), respectively. The above figures show a markedly improved survival rate post-1993, albeit without a statistical significance.

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