PMID- 19695791
OWN - NLM
STAT- MEDLINE
DCOM- 20100428
LR  - 20211020
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Print)
IS  - 0360-3016 (Linking)
VI  - 77
IP  - 1
DP  - 2010 May 1
TI  - Portal hypertension in children with Wilms' tumor: a report from the National 
      Wilms' Tumor Study Group.
PG  - 210-6
LID - 10.1016/j.ijrobp.2009.04.057 [doi]
AB  - PURPOSE: This analysis was undertaken to determine the cumulative risk of and 
      risk factors for portal hypertension (PHTN) in patients with Wilms' tumor (WT). 
      METHODS AND MATERIALS: Medical records were reviewed to identify cases of PHTN 
      identified with late liver/spleen/gastric toxicities in a cohort of 5,195 
      patients treated with National Wilms' Tumor Studies (NWTS) protocols 1 to 4. A 
      nested case control study (5 controls/case) was conducted to determine 
      relationships among doxorubicin, radiation therapy (RT) dose to the liver, 
      patient gender, and PHTN. Conditional logistic regression was used to estimate 
      adjusted hazard ratios (HR) of PHTN associated with these factors. RESULTS: 
      Cumulative risk of PHTN at 6 years from WT diagnosis was 0.7% for patients with 
      right-sided tumors vs. 0.1% for those with left-sided tumors (p = 0.002). 
      Seventeen of 19 cases were evaluable for RT. The majority of cases (16/17 [94%]) 
      received right-flank RT either alone or as part of whole-abdomen RT and received 
      >15 Gy to the liver. Fifteen of 17 (88%) patients received a higher dose to the 
      liver than they would have with modern WT protocols. Controlling for RT dose, the 
      HR was 3.0 for patients who received doxorubicin (p = 0.32) and 2.8 for females 
      (p = 0.15). Controlling for doxorubicin, the 95% lower confidence bound on the HR 
      associating PHTN with a minimum liver RT dose of >15 Gy vs. <or=15 Gy was 2.5 (p 
      = 0.001); it was 2.4 for a maximum liver dose of >15 Gy vs. <or=15 Gy (p = 
      0.001). CONCLUSIONS: There was a strong association between higher doses of liver 
      RT (>15 Gy) and the development of PHTN among WT patients.
FAU - Warwick, Anne B
AU  - Warwick AB
AD  - Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 
      53326, USA. awarwick@mcw.edu
FAU - Kalapurakal, John A
AU  - Kalapurakal JA
FAU - Ou, San-San
AU  - Ou SS
FAU - Green, Daniel M
AU  - Green DM
FAU - Norkool, Pat A
AU  - Norkool PA
FAU - Peterson, Susan M
AU  - Peterson SM
FAU - Breslow, Norman E
AU  - Breslow NE
LA  - eng
GR  - R01 CA054498/CA/NCI NIH HHS/United States
GR  - R01 CA054498-09/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20090819
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
RN  - 0 (Antibiotics, Antineoplastic)
RN  - 80168379AG (Doxorubicin)
SB  - IM
MH  - Antibiotics, Antineoplastic/*adverse effects
MH  - Case-Control Studies
MH  - Child
MH  - Child, Preschool
MH  - Combined Modality Therapy/adverse effects
MH  - Doxorubicin/*adverse effects
MH  - Female
MH  - Humans
MH  - Hypertension, Portal/*etiology
MH  - *Kidney Neoplasms/drug therapy/pathology/radiotherapy
MH  - Liver/blood supply/drug effects/*radiation effects
MH  - Logistic Models
MH  - Male
MH  - Proportional Hazards Models
MH  - Radiotherapy Dosage
MH  - Risk
MH  - Spleen/drug effects/radiation effects
MH  - *Wilms Tumor/drug therapy/pathology/radiotherapy
PMC - PMC2888002
MID - NIHMS198436
COIS- CONFLICT OF INTEREST None of the authors has any conflict of interest to 
      disclose.
EDAT- 2009/08/22 09:00
MHDA- 2010/04/29 06:00
PMCR- 2011/05/01
CRDT- 2009/08/22 09:00
PHST- 2009/02/23 00:00 [received]
PHST- 2009/04/17 00:00 [revised]
PHST- 2009/04/22 00:00 [accepted]
PHST- 2009/08/22 09:00 [entrez]
PHST- 2009/08/22 09:00 [pubmed]
PHST- 2010/04/29 06:00 [medline]
PHST- 2011/05/01 00:00 [pmc-release]
AID - S0360-3016(09)00656-7 [pii]
AID - 10.1016/j.ijrobp.2009.04.057 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2010 May 1;77(1):210-6. doi: 
      10.1016/j.ijrobp.2009.04.057. Epub 2009 Aug 19.