Abstract
Purpose: To review event-free (EFS) and overall survival (OS) from publications describing outcome for children with relapsed Wilms' tumour. Comparisons are made between those receiving myeloablative high dose chemotherapy with autologous stem-cell rescue (HDT) and those not (NoHDT). Materials and methods: Relevant information was extracted from individual patient or summary data and 3-year EFS and OS rates established. These rates were combined in a weighted manner to derive hazard ratios (HRs). Results: Nineteen publications were identified (5 HDT, 6 NoHDT, 8 both). Pooling all studies suggested an advantage to HDT with a hazard ratio (HR) for EFS of 0.87 (95% confidence interval (CI) 0.67-1.12) and 0.94 (0.71-1.24) for OS. A stratified analysis confined to studies that provided individual patient data on both HDT and NoHDT gave HRs of 0.83 (0.56-1.24) and 0.92 (0.59-1.41). Further, analyses of risk groups, defined by treatment and/or histology prior to first relapse, suggested a HR for EFS of 0.90 (95% CI 0.62-1.31) for those of high and 0.50 (CI 0.31-0.82) for the very high risk patients. Conclusion: The evidence suggests, although there are many caveats since the information summarised here is not from randomised trials, a great deal of uncertainty concerning the role of HDT in patients following relapse after treatment for their Wilms' tumour. For each risk group we propose a randomised trial comparing a standard with a more intensive therapy with specific choice of regimen tailored to the risk group (and co-operative groups) concerned. A synthesis of updated evidence from studies in this overview together with any emerging studies and future trial information will form the basis for future evidence-based clinical decision-making.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 194-210 |
| Number of pages | 17 |
| Journal | European Journal of Cancer |
| Volume | 49 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2013 |
| Externally published | Yes |
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Keywords
- High dose chemotherapy
- Relapsed Wilms' tumour
- Wilms' tumour
ASJC Scopus subject areas
- Oncology
- Cancer Research
Cite this
An international strategy to determine the role of high dose therapy in recurrent Wilms' tumour. / Ha, Tam C.; Spreafico, Filippo; Graf, Norbert; Dallorso, Sandro; Dome, Jeffrey S.; Malogolowkin, Marcio; Furtwängler, Rhoikos; Hale, Juliet P.; Moroz, Veronica; MacHin, David; Pritchard-Jones, Kathy.
In: European Journal of Cancer, Vol. 49, No. 1, 01.01.2013, p. 194-210.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - An international strategy to determine the role of high dose therapy in recurrent Wilms' tumour
AU - Ha, Tam C.
AU - Spreafico, Filippo
AU - Graf, Norbert
AU - Dallorso, Sandro
AU - Dome, Jeffrey S.
AU - Malogolowkin, Marcio
AU - Furtwängler, Rhoikos
AU - Hale, Juliet P.
AU - Moroz, Veronica
AU - MacHin, David
AU - Pritchard-Jones, Kathy
PY - 2013/1/1
Y1 - 2013/1/1
N2 - Purpose: To review event-free (EFS) and overall survival (OS) from publications describing outcome for children with relapsed Wilms' tumour. Comparisons are made between those receiving myeloablative high dose chemotherapy with autologous stem-cell rescue (HDT) and those not (NoHDT). Materials and methods: Relevant information was extracted from individual patient or summary data and 3-year EFS and OS rates established. These rates were combined in a weighted manner to derive hazard ratios (HRs). Results: Nineteen publications were identified (5 HDT, 6 NoHDT, 8 both). Pooling all studies suggested an advantage to HDT with a hazard ratio (HR) for EFS of 0.87 (95% confidence interval (CI) 0.67-1.12) and 0.94 (0.71-1.24) for OS. A stratified analysis confined to studies that provided individual patient data on both HDT and NoHDT gave HRs of 0.83 (0.56-1.24) and 0.92 (0.59-1.41). Further, analyses of risk groups, defined by treatment and/or histology prior to first relapse, suggested a HR for EFS of 0.90 (95% CI 0.62-1.31) for those of high and 0.50 (CI 0.31-0.82) for the very high risk patients. Conclusion: The evidence suggests, although there are many caveats since the information summarised here is not from randomised trials, a great deal of uncertainty concerning the role of HDT in patients following relapse after treatment for their Wilms' tumour. For each risk group we propose a randomised trial comparing a standard with a more intensive therapy with specific choice of regimen tailored to the risk group (and co-operative groups) concerned. A synthesis of updated evidence from studies in this overview together with any emerging studies and future trial information will form the basis for future evidence-based clinical decision-making.
AB - Purpose: To review event-free (EFS) and overall survival (OS) from publications describing outcome for children with relapsed Wilms' tumour. Comparisons are made between those receiving myeloablative high dose chemotherapy with autologous stem-cell rescue (HDT) and those not (NoHDT). Materials and methods: Relevant information was extracted from individual patient or summary data and 3-year EFS and OS rates established. These rates were combined in a weighted manner to derive hazard ratios (HRs). Results: Nineteen publications were identified (5 HDT, 6 NoHDT, 8 both). Pooling all studies suggested an advantage to HDT with a hazard ratio (HR) for EFS of 0.87 (95% confidence interval (CI) 0.67-1.12) and 0.94 (0.71-1.24) for OS. A stratified analysis confined to studies that provided individual patient data on both HDT and NoHDT gave HRs of 0.83 (0.56-1.24) and 0.92 (0.59-1.41). Further, analyses of risk groups, defined by treatment and/or histology prior to first relapse, suggested a HR for EFS of 0.90 (95% CI 0.62-1.31) for those of high and 0.50 (CI 0.31-0.82) for the very high risk patients. Conclusion: The evidence suggests, although there are many caveats since the information summarised here is not from randomised trials, a great deal of uncertainty concerning the role of HDT in patients following relapse after treatment for their Wilms' tumour. For each risk group we propose a randomised trial comparing a standard with a more intensive therapy with specific choice of regimen tailored to the risk group (and co-operative groups) concerned. A synthesis of updated evidence from studies in this overview together with any emerging studies and future trial information will form the basis for future evidence-based clinical decision-making.
KW - High dose chemotherapy
KW - Relapsed Wilms' tumour
KW - Wilms' tumour
UR - http://www.scopus.com/inward/record.url?scp=84871435281&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871435281&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2012.07.010
DO - 10.1016/j.ejca.2012.07.010
M3 - Article
C2 - 22959164
AN - SCOPUS:84871435281
VL - 49
SP - 194
EP - 210
JO - European Journal of Cancer
JF - European Journal of Cancer
SN - 0959-8049
IS - 1
ER -