PMID- 31396736
OWN - NLM
STAT- MEDLINE
DCOM- 20191230
LR  - 20200225
IS  - 1437-9813 (Electronic)
IS  - 0179-0358 (Linking)
VI  - 35
IP  - 10
DP  - 2019 Oct
TI  - Factors responsible for stage III disease in patients with Wilms tumor enrolled 
      in the JWiTS-2 study.
PG  - 1095-1099
LID - 10.1007/s00383-019-04531-z [doi]
AB  - BACKGROUND/OBJECTIVES: Treatment is more intensive for stage III Wilms tumor (WT) 
      than for stages I and II non-metastatic WTs. Various factors including tumor 
      spillage, unresectability, and lymph node metastasis are responsible for stage 
      III disease. The present study aimed to not identify clinical factors associated 
      with the features of stage III WT to establish new treatment strategies. 
      DESIGN/METHODS: Of 166 patients with non-metastatic WT enrolled in the Japan 
      Wilms Tumor Study (JWiTS)-2, 51 patients had stage III disease. The treatment 
      protocol for JWiTS-2 was essentially the same as that in the National Wilms Tumor 
      study (NWTS)-5. Local hospitals were surveyed to collect details of clinical 
      findings related to stage III disease, and data regarding 45 (88%) patients were 
      obtained. RESULTS: Nine patients with massive tumors underwent preoperative 
      chemotherapy. Biopsy was performed in 6. Reduction in the tumor size was achieved 
      in 8 of the 9 cases. Nephrectomy was finally performed in all of them. Thirty-six 
      patients underwent primary nephrectomy. The reason for the stage III disease was 
      lymph node metastasis (n = 9, 25%), tumor spillage (n = 20, 56%), and tumor 
      extension/incomplete resection (n = 17, 47%). Some patients had more than one of 
      these factors. Most patients were treated with the DD-4A regimen, and 43 (95.6%) 
      of the 45 patients received abdominal radiation therapy. Tumors recurred in three 
      patients (local, 1; metastasis, 2), and two patients died. Overall and 
      relapse-free survival rates were 95.2% and 90.8%, respectively. CONCLUSION: The 
      prognosis of stage III WT was good. In the next stage, the doses of chemotherapy 
      and radiotherapy should be reduced to avoid late effects. The high rate of tumor 
      spillage after primary resection suggests that preoperative chemotherapy should 
      be started instead of aggressive tumor resection in the large tumor cases with 
      surgical risks.
FAU - Oue, Takaharu
AU  - Oue T
AD  - Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, 
      Nishinomiya, 63-8501, Hyogo, Japan. ta-oue@hyo-med.ac.jp.
FAU - Fukumoto, Koji
AU  - Fukumoto K
AD  - Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
FAU - Souzaki, Ryota
AU  - Souzaki R
AD  - Department of Pediatric Surgery, Kyushu University Graduate School on Medicine, 
      Fukuoka, Japan.
FAU - Takimoto, Tetsuya
AU  - Takimoto T
AD  - Department of Childhood Cancer Data Management, National Center for Child Health 
      and Development, Tokyo, Japan.
FAU - Koshinaga, Tsugumichi
AU  - Koshinaga T
AD  - Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, 
      Japan.
CN  - Renal tumor Committee of the Japanese Children's Cancer Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20190808
PL  - Germany
TA  - Pediatr Surg Int
JT  - Pediatric surgery international
JID - 8609169
SB  - IM
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Infant
MH  - Japan/epidemiology
MH  - Kidney Neoplasms/*diagnosis/mortality/therapy
MH  - Male
MH  - Neoplasm Staging/*methods
MH  - Prognosis
MH  - Survival Rate/trends
MH  - Wilms Tumor/*diagnosis/mortality/therapy
OTO - NOTNLM
OT  - JWiTS
OT  - Spillage
OT  - Stage III
OT  - Wilms tumor
EDAT- 2019/08/10 06:00
MHDA- 2019/12/31 06:00
CRDT- 2019/08/10 06:00
PHST- 2019/08/01 00:00 [accepted]
PHST- 2019/08/10 06:00 [pubmed]
PHST- 2019/12/31 06:00 [medline]
PHST- 2019/08/10 06:00 [entrez]
AID - 10.1007/s00383-019-04531-z [pii]
AID - 10.1007/s00383-019-04531-z [doi]
PST - ppublish
SO  - Pediatr Surg Int. 2019 Oct;35(10):1095-1099. doi: 10.1007/s00383-019-04531-z. 
      Epub 2019 Aug 8.