The treatment of Wilms' tumor patients with pulmonary metastases detected only with computed tomography: a report from the National Wilms' Tumor Study.

Abstract

To evaluate the prognosis of patients with Wilms' tumor who have pulmonary densities identified on a computed tomographic (CT) scan of the chest, but have a negative plain chest radiograph, we reviewed the treatments and outcome of 32 patients randomized or followed on National Wilms' Tumor Study (NWTS)-3. The 4-year event-free and overall survival percentages of 18 of these patients who had a favorable histology tumor and were treated as stage IV tumors with three or four drugs plus whole-lung irradiation were 88.1% and 94.0%, respectively. The 4-year event-free and overall survival percentages for nine favorable histology patients treated less aggressively based on the extent of locoregional disease with two or three drugs and without whole-lung irradiation were 88.9% and 88.0%, respectively. There were no statistically significant differences in the 4-year event-free or overall survival percentages between the two groups. The current data do not demonstrate improved survival for favorable histology patients treated with whole-lung irradiation for pulmonary metastases identified only on chest CT scan. However, due to the small number of patients included, no statistically valid conclusions regarding the roles of Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) and/or whole-lung irradiation in the treatment of these patients can be drawn from the present analysis. Additional patients need to be systematically studied to determine if these preliminary observations can be confirmed.

The value of surgery in directing therapy for patients with Wilms' tumor with pulmonary disease. A report from the National Wilms' Tumor Study Group (National Wilms' Tumor Study 5)

“…Survival outcomes in children with CT-only disease have been described in the literature but in very small numbers [10,[13][14][15]17,18]. Wilimas et al [18] reported on 11 patients with favorable histology and a normal CXR and CT pulmonary lesion.…”

“…Computed tomography-only lesions have been the subject of reports from the NWTS Group [10,13,14,17]. In NWTS-3 and NWTS-4 children with favorable-histology tumors and pulmonary densities identified only by CT scan were treated either as stage IV or local regional disease stage [14,17].…”

Commentary: Imaging and staging of Wilms' tumors: Problems and controversies

“…The reasons for not recommending a CT scan of the chest are based on an article by Green et al published in 1991 [3]. In summary, these workers evaluated 27 patients with nodules detected on chest CT but not on chest radiograph.…”

“…First, some of the articles published by radiologists represent experience in single institutions and therefore lack adequate numbers of patients for meaningful analysis [1,2]. Second, several recent publications on the imaging of Wilms' tumor have not included any radiologists as co-investigators and authors and consequently have flaws in technique and analysis [3][4][5].…”

Influence of Pulmonary Nodules on Chest Computed Tomography and Risk of Recurrence in Stage IV Wilms Tumor

“…Available data suggest there are no significant differences between event-free and OS rates when computed tomography (CT) is used rather than chest radiography (CXR) for diagnosis of pulmonary lesions (5,6). However, the validity of studies justifying the use of only CXR has also never been verified, and available data are based on small, retrospective studies.…”