Timing of Radiation Therapy in Pediatric Wilms Tumor: A Report From the National Cancer Database

To determine, using the National Cancer Database (NCDB), the impact of the surgery to radiation therapy interval (SRI) on survival in contemporary patients with Wilms tumor (WT).

The NCDB was queried for patients aged ≤25 years diagnosed from 2004 to 2013 with unilateral WT who underwent definitive surgery and radiation therapy. The SRI was calculated for each patient. A stratified analysis was performed based on presence of metastasis using logistic regression to calculate risk factors for prolonged SRI, with a focus on the recommended SRI according to recent Children's Oncology Group trials (by day 14) and National Wilms Tumor Study-5 (by day 9). Cox regression was performed to assess the association of SRI with overall survival.

A total of 1488 patients were included; 32.1% had metastasis at diagnosis. Among both metastatic and nonmetastatic groups, older patients were more likely to have prolonged SRI. For those without metastasis, SRI > 14 days was associated with increased risk of mortality (hazard ratio 2.13, P = .013). Analyzing SRI as a continuous variable also demonstrated an increased risk of death with longer SRI (hazard ratio 1.04 per day, P = .006) in this group. In contrast, among patients with metastasis, no significant association between SRI and mortality was found.

Early initiation of radiation therapy remains a critical component of multimodal treatment for patients with nonmetastatic WT. For nonmetastatic patients, SRI ≤ 14 days correlates with improved overall survival. However, no such association was noted for patients with metastases. These results may inform the development of future WT trials.

International journal of radiation oncology, biology, physics. 2018 Feb 06 [Epub ahead of print]

Claire L Stokes, William A Stokes, John A Kalapurakal, Arnold C Paulino, Nicholas G Cost, Carrye R Cost, Timothy P Garrington, Brian S Greffe, Jonathan P Roach, Jennifer L Bruny, Arthur K Liu

Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. Electronic address: ., Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado., Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas., Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado., Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado., Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.

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