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Immediate nephrectomy versus preoperative chemotherapy in the management of non-metastatic Wilms' tumour: Results of a randomised trial (UKW3) by the UK Children's Cancer Study Group

Lookup NU author(s): Dr Juliet Hale

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Abstract

Purpose: To determine if patients receiving preoperative chemotherapy with vincristine and actinomycin D for non-metastatic Wilms' tumour have a more advantageous stage distribution and so need less treatment compared to patients who have immediate nephrectomy, without adversely affecting outcome. Methods: Between 1991 and 2001, a total of 205 patients with newly diagnosed non-metastatic renal tumours, of which 186 had Wilms' histologies, were randomly assigned either to immediate surgery or to 6 weeks preoperative chemotherapy and then delayed surgery. Both groups of children received postoperative chemotherapy according to tumour stage and histology determined at the time of nephrectomy Results: There was a significant improvement in the stage distribution for patients with Wilms' histologies receiving delayed surgery compared to those having immediate nephrectomy (stage L 65.2% versus 54.3%; stage 11: 23.9% versus 14.9%; stage 111: 9.8% versus 29.8%, chi(2) test for trend = 7.02, p = 0.008). This improvement resulted in 20% fewer children receiving radiotherapy or doxorubicin yet event-free and overall survivals at 5 years of 79.6% and 89.0%, respectively, were similar in the two groups. Conclusion: Six weeks of preoperative chemotherapy with vincristine and actinomycin D results in a significant shift towards a more advantageous stage distribution and hence reduction in therapy, while maintaining excellent event free and overall survival in children with non-metastatic Wilms' tumour. Around 20% of survivors were therefore spared the late-effects of doxorubicin or radiotherapy. Our results suggest that all children with non-metastatic Wilms' tumour should receive chemotherapy prior to tumour resection. (c) 2006 Elsevier Ltd. All rights reserved.

Publication metadata

Author(s): Mitchell C, Pritchard-Jones K, Shannon R, Hutton C, Stevens S, Machin D, Imeson J, Kelsey A, Vujanic GM, Gornall P, Walker J, Taylor R, Sartori P, Hale J, Levitt G, Messahel B, Middleton H, Grundy R, Pritchard J, United Kingdom Cancer Study Group

Publication type: Article

Publication status: Published

Journal: European Journal of Cancer

Year: 2006

Volume: 42

Issue: 15

Pages: 2554-2562

ISSN (print): 0959-8049

ISSN (electronic): 1879-0852

Publisher: Pergamon

URL: http://dx.doi.org/10.1016/j.ejca.2006.05.026

DOI: 10.1016/j.ejca.2006.05.026

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