Recurrent Wilms tumor: routine CT may be unnecessary

  • Mullen EA & al.
  • J Clin Oncol
  • 18.10.2018

  • von Deepa Koli
  • Studien – kurz & knapp
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Takeaway

  • Use of CT scans for routine surveillance does not improve survival in patients with recurrent unilateral favorable-histology Wilms tumor vs surveillance with chest X-ray or abdominal ultrasound (CXR/US).

Why this matters

  • Eliminating CT scans from surveillance will reduce radiation exposure and healthcare costs without affecting survival.

Study design

  • 281 patients with recurrent unilateral favorable-histology Wilms tumor from fifth National Wilms Tumor Study.
  • Funding: NIH; others.

Key results

  • The recurrences were detected with signs/symptoms (25%), surveillance imaging with CT (26.5%), or CXR/US (48.5%). 
  • 5-year OS was similar in patients whose recurrences were detected with signs/symptoms vs surveillance imaging (59% vs 70%; P=.23).
  • 5-year OS rate in patients in whom recurrences were detected by CXR/US vs CT was statistically similar (73% vs 65%; P=.20):
    • patients with stages I or II favorable-histology Wilms tumor (79% vs 85%; P=.53),
    • patients with initial stages III and IV disease (66% vs 52%; P=.11),
    • patients with stage IV disease (64% vs 48%; P=.17), and
    • patients with lung-only relapse (73% vs 73%; P=.91).
  • 5-year OS rate was significantly higher in patients with recurrence at other sites detected by CXR/US vs CT (72% vs 48%; P=.02).

Limitations

  • Retrospective design.