PMID- 10348287
OWN - NLM
STAT- MEDLINE
DCOM- 19990608
LR  - 20190708
IS  - 0360-3016 (Print)
IS  - 0360-3016 (Linking)
VI  - 44
IP  - 3
DP  - 1999 Jun 1
TI  - Significance and management of computed tomography detected pulmonary nodules: a 
      report from the National Wilms Tumor Study Group.
PG  - 579-85
AB  - PURPOSE: To define the optimal treatment for children with Wilms tumor who have 
      pulmonary nodules identified on chest computed tomography (CT) scan, but have a 
      negative chest radiograph, we evaluated the outcome of all such patients 
      randomized or followed on National Wilms Tumor Study (NWTS)-3 and -4. PATIENTS 
      AND METHODS: We estimated the event-free and overall survival percentages of 53 
      patients with favorable histology tumors and pulmonary densities identified only 
      by CT scan (CT-only) who were treated as Stage IV with intensive 
      doxorubicin-containing chemotherapy and whole-lung irradiation, and compared 
      these to the event-free and overall survival percentages of 37 CT-only patients 
      who were treated less aggressively based on the extent of locoregional disease 
      with 2 or 3 drugs, and without whole-lung irradiation. RESULTS: The 4-year 
      event-free and overall survival percentages of the 53 patients with CT-only 
      nodules and favorable histology Wilms tumor who were treated as Stage IV were 89% 
      and 91%, respectively. The 4-year event-free and overall survival percentages for 
      the 37 patients with CT-only nodules and favorable histology who were treated 
      according to the extent of locoregional disease were 80% and 85%, respectively. 
      The differences observed between the 2 groups were not statistically significant. 
      Among the patients who received whole-lung irradiation, there were fewer 
      pulmonary relapses, but more deaths attributable to lung toxicity. CONCLUSIONS: 
      The current data raise the possibility that children with Wilms tumor and CT-only 
      pulmonary nodules who receive whole lung irradiation have fewer pulmonary 
      relapses, but a greater number of deaths due to treatment toxicity. The role of 
      whole lung irradiation in the treatment of this group of patients cannot be 
      definitively determined based on the present data. Prolonged follow-up of this 
      group of patients is necessary to accurately estimate the frequency of late, 
      treatment-related mortality.
FAU - Meisel, J A
AU  - Meisel JA
AD  - Department of Radiation Oncology, Stanford University School of Medicine, CA, 
      USA.
FAU - Guthrie, K A
AU  - Guthrie KA
FAU - Breslow, N E
AU  - Breslow NE
FAU - Donaldson, S S
AU  - Donaldson SS
FAU - Green, D M
AU  - Green DM
LA  - eng
GR  - CA-42326/CA/NCI NIH HHS/United States
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
RN  - 1CC1JFE158 (Dactinomycin)
RN  - 5J49Q6B70F (Vincristine)
RN  - 80168379AG (Doxorubicin)
RN  - 8N3DW7272P (Cyclophosphamide)
SB  - IM
MH  - Adolescent
MH  - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
MH  - Biopsy
MH  - Child
MH  - Cyclophosphamide/administration & dosage
MH  - Dactinomycin/administration & dosage
MH  - Disease-Free Survival
MH  - Doxorubicin/administration & dosage
MH  - Humans
MH  - Kidney Neoplasms/*pathology
MH  - Lung/pathology
MH  - Lung Neoplasms/diagnostic imaging/drug therapy/mortality/*secondary
MH  - Multicenter Studies as Topic
MH  - Neoplasm Staging
MH  - Prognosis
MH  - Radiotherapy/adverse effects
MH  - Radiotherapy Dosage
MH  - Randomized Controlled Trials as Topic
MH  - Solitary Pulmonary Nodule/diagnostic imaging/drug 
      therapy/mortality/radiotherapy/*secondary
MH  - Tomography, X-Ray Computed
MH  - Vincristine/administration & dosage
MH  - Wilms Tumor/diagnostic imaging/drug therapy/mortality/radiotherapy/*secondary
EDAT- 1999/05/29 00:00
MHDA- 1999/05/29 00:01
CRDT- 1999/05/29 00:00
PHST- 1999/05/29 00:00 [pubmed]
PHST- 1999/05/29 00:01 [medline]
PHST- 1999/05/29 00:00 [entrez]
AID - S0360-3016(99)00086-3 [pii]
AID - 10.1016/s0360-3016(99)00086-3 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 1999 Jun 1;44(3):579-85. doi: 
      10.1016/s0360-3016(99)00086-3.