Impact of surveillance imaging modality on survival after recurrence in patients with favorable-histology Wilms tumor: A report from the children’s oncology group

Elizabeth A. Mullen, Yueh Yun Chi, Emily Hibbitts, James R. Anderson, Katarina J. Steacy, James I. Geller, Daniel M. Green, Geetika Khanna, Marcio Malogolowkin, Paul E. Grundy, Conrad V. Fernandez, Jeffrey S. Dome

Research output: Contribution to journalArticle

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Abstract

Purpose The use of computed tomography (CT) for routine surveillance to detect recurrence in patients with Wilms tumor (WT) has increased in recent years. The utility of CT, despite increased risk and cost, to improve outcome for these patients is unknown. We conducted a retrospective analysis with patients enrolled in the fifth National Wilms Tumor Study (NWTS-5) to determine if surveillance with CT correlates with improved overall survival (OS) after recurrence compared with chest x-ray (CXR) and abdominal ultrasound (US). Patients and Methods Overall, 281 patients with recurrent unilateral favorable-histology WT were reviewed to assess how WT recurrence was detected: sign/symptoms (SS), surveillance imaging (SI) with CT scan, or SI with CXR/US. Results The estimated 5-year OS rate after relapse was 67% (95% CI, 61% to 72%). Twenty-five percent of recurrences were detected with SS; 48.5%, with CXR/US; and 26.5%, with CT. Patients with SS had a 5-year OS rate of 59% (95% CI, 46% to 72%) compared with 70% (95% CI, 63% to 77%; P = .23) for those detected by SI. Recurrences detected by CT had a shorter median time from diagnosis to recurrence (0.60 years) compared with SS (0.91 years) or CXR/US (0.86 years; P = .003). For recurrences detected by SI, more tumor foci at relapse (P, .001) and size of the largest focus greater than 2 cm (P = .02) were associated with inferior OS. However, there was no difference in OS after relapse when recurrence was detected by CT versus CXR/US (5-year OS rate, 65% v 73%; P = .20). Conclusion In patients with favorable-histology WT, elimination of CT scans from surveillance programs is unlikely to compromise survival but would result in substantial reduction in radiation exposure and health care costs.

Original languageEnglish (US)
Pages (from-to)3396-3403
Number of pages8
JournalJournal of Clinical Oncology
Volume36
Issue number34
DOIs
StatePublished - Dec 1 2018

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Wilms Tumor
Histology
Recurrence
Survival
Tomography
Thorax
X-Rays
Signs and Symptoms
Survival Rate
Pyridinolcarbamate
Health Care Costs
Costs and Cost Analysis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Impact of surveillance imaging modality on survival after recurrence in patients with favorable-histology Wilms tumor : A report from the children’s oncology group. / Mullen, Elizabeth A.; Chi, Yueh Yun; Hibbitts, Emily; Anderson, James R.; Steacy, Katarina J.; Geller, James I.; Green, Daniel M.; Khanna, Geetika; Malogolowkin, Marcio; Grundy, Paul E.; Fernandez, Conrad V.; Dome, Jeffrey S.

In: Journal of Clinical Oncology, Vol. 36, No. 34, 01.12.2018, p. 3396-3403.

Research output: Contribution to journalArticle

Mullen, EA, Chi, YY, Hibbitts, E, Anderson, JR, Steacy, KJ, Geller, JI, Green, DM, Khanna, G, Malogolowkin, M, Grundy, PE, Fernandez, CV & Dome, JS 2018, 'Impact of surveillance imaging modality on survival after recurrence in patients with favorable-histology Wilms tumor: A report from the children’s oncology group', Journal of Clinical Oncology, vol. 36, no. 34, pp. 3396-3403. https://doi.org/10.1200/JCO.18.00076
Mullen, Elizabeth A. ; Chi, Yueh Yun ; Hibbitts, Emily ; Anderson, James R. ; Steacy, Katarina J. ; Geller, James I. ; Green, Daniel M. ; Khanna, Geetika ; Malogolowkin, Marcio ; Grundy, Paul E. ; Fernandez, Conrad V. ; Dome, Jeffrey S. / Impact of surveillance imaging modality on survival after recurrence in patients with favorable-histology Wilms tumor : A report from the children’s oncology group. In: Journal of Clinical Oncology. 2018 ; Vol. 36, No. 34. pp. 3396-3403.
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title = "Impact of surveillance imaging modality on survival after recurrence in patients with favorable-histology Wilms tumor: A report from the children’s oncology group",
abstract = "Purpose The use of computed tomography (CT) for routine surveillance to detect recurrence in patients with Wilms tumor (WT) has increased in recent years. The utility of CT, despite increased risk and cost, to improve outcome for these patients is unknown. We conducted a retrospective analysis with patients enrolled in the fifth National Wilms Tumor Study (NWTS-5) to determine if surveillance with CT correlates with improved overall survival (OS) after recurrence compared with chest x-ray (CXR) and abdominal ultrasound (US). Patients and Methods Overall, 281 patients with recurrent unilateral favorable-histology WT were reviewed to assess how WT recurrence was detected: sign/symptoms (SS), surveillance imaging (SI) with CT scan, or SI with CXR/US. Results The estimated 5-year OS rate after relapse was 67{\%} (95{\%} CI, 61{\%} to 72{\%}). Twenty-five percent of recurrences were detected with SS; 48.5{\%}, with CXR/US; and 26.5{\%}, with CT. Patients with SS had a 5-year OS rate of 59{\%} (95{\%} CI, 46{\%} to 72{\%}) compared with 70{\%} (95{\%} CI, 63{\%} to 77{\%}; P = .23) for those detected by SI. Recurrences detected by CT had a shorter median time from diagnosis to recurrence (0.60 years) compared with SS (0.91 years) or CXR/US (0.86 years; P = .003). For recurrences detected by SI, more tumor foci at relapse (P, .001) and size of the largest focus greater than 2 cm (P = .02) were associated with inferior OS. However, there was no difference in OS after relapse when recurrence was detected by CT versus CXR/US (5-year OS rate, 65{\%} v 73{\%}; P = .20). Conclusion In patients with favorable-histology WT, elimination of CT scans from surveillance programs is unlikely to compromise survival but would result in substantial reduction in radiation exposure and health care costs.",
author = "Mullen, {Elizabeth A.} and Chi, {Yueh Yun} and Emily Hibbitts and Anderson, {James R.} and Steacy, {Katarina J.} and Geller, {James I.} and Green, {Daniel M.} and Geetika Khanna and Marcio Malogolowkin and Grundy, {Paul E.} and Fernandez, {Conrad V.} and Dome, {Jeffrey S.}",
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T1 - Impact of surveillance imaging modality on survival after recurrence in patients with favorable-histology Wilms tumor

T2 - A report from the children’s oncology group

AU - Mullen, Elizabeth A.

AU - Chi, Yueh Yun

AU - Hibbitts, Emily

AU - Anderson, James R.

AU - Steacy, Katarina J.

AU - Geller, James I.

AU - Green, Daniel M.

AU - Khanna, Geetika

AU - Malogolowkin, Marcio

AU - Grundy, Paul E.

AU - Fernandez, Conrad V.

AU - Dome, Jeffrey S.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Purpose The use of computed tomography (CT) for routine surveillance to detect recurrence in patients with Wilms tumor (WT) has increased in recent years. The utility of CT, despite increased risk and cost, to improve outcome for these patients is unknown. We conducted a retrospective analysis with patients enrolled in the fifth National Wilms Tumor Study (NWTS-5) to determine if surveillance with CT correlates with improved overall survival (OS) after recurrence compared with chest x-ray (CXR) and abdominal ultrasound (US). Patients and Methods Overall, 281 patients with recurrent unilateral favorable-histology WT were reviewed to assess how WT recurrence was detected: sign/symptoms (SS), surveillance imaging (SI) with CT scan, or SI with CXR/US. Results The estimated 5-year OS rate after relapse was 67% (95% CI, 61% to 72%). Twenty-five percent of recurrences were detected with SS; 48.5%, with CXR/US; and 26.5%, with CT. Patients with SS had a 5-year OS rate of 59% (95% CI, 46% to 72%) compared with 70% (95% CI, 63% to 77%; P = .23) for those detected by SI. Recurrences detected by CT had a shorter median time from diagnosis to recurrence (0.60 years) compared with SS (0.91 years) or CXR/US (0.86 years; P = .003). For recurrences detected by SI, more tumor foci at relapse (P, .001) and size of the largest focus greater than 2 cm (P = .02) were associated with inferior OS. However, there was no difference in OS after relapse when recurrence was detected by CT versus CXR/US (5-year OS rate, 65% v 73%; P = .20). Conclusion In patients with favorable-histology WT, elimination of CT scans from surveillance programs is unlikely to compromise survival but would result in substantial reduction in radiation exposure and health care costs.

AB - Purpose The use of computed tomography (CT) for routine surveillance to detect recurrence in patients with Wilms tumor (WT) has increased in recent years. The utility of CT, despite increased risk and cost, to improve outcome for these patients is unknown. We conducted a retrospective analysis with patients enrolled in the fifth National Wilms Tumor Study (NWTS-5) to determine if surveillance with CT correlates with improved overall survival (OS) after recurrence compared with chest x-ray (CXR) and abdominal ultrasound (US). Patients and Methods Overall, 281 patients with recurrent unilateral favorable-histology WT were reviewed to assess how WT recurrence was detected: sign/symptoms (SS), surveillance imaging (SI) with CT scan, or SI with CXR/US. Results The estimated 5-year OS rate after relapse was 67% (95% CI, 61% to 72%). Twenty-five percent of recurrences were detected with SS; 48.5%, with CXR/US; and 26.5%, with CT. Patients with SS had a 5-year OS rate of 59% (95% CI, 46% to 72%) compared with 70% (95% CI, 63% to 77%; P = .23) for those detected by SI. Recurrences detected by CT had a shorter median time from diagnosis to recurrence (0.60 years) compared with SS (0.91 years) or CXR/US (0.86 years; P = .003). For recurrences detected by SI, more tumor foci at relapse (P, .001) and size of the largest focus greater than 2 cm (P = .02) were associated with inferior OS. However, there was no difference in OS after relapse when recurrence was detected by CT versus CXR/US (5-year OS rate, 65% v 73%; P = .20). Conclusion In patients with favorable-histology WT, elimination of CT scans from surveillance programs is unlikely to compromise survival but would result in substantial reduction in radiation exposure and health care costs.

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