Journal of Clinical Oncology, Vol 1, 604-609, Copyright © 1983 by American Society of Clinical Oncology
Effectiveness of preoperative chemotherapy in Wilms' tumor: results of an International Society of Paediatric Oncology (SIOP) clinical trial
J Lemerle, PA Voute, MF Tournade, C Rodary, JF Delemarre, D Sarrazin, JM Burgers, B Sandstedt, H Mildenberger and M Carli
The results of a controlled clinical trial of preoperative radiotherapy
compared to chemotherapy in patients with nephroblastoma are presented. Of
397 histologically proven cases of Wilms' tumor registered at 34 centers
between January 1977 and July 1979, 164 were eligible for the trial and
were randomized to receive preoperative radiotherapy and chemotherapy
(group R, 76 patients) or preoperative chemotherapy (group C, 88 patients).
The results were evaluated in terms of the number of surgical tumor
ruptures and of local tumor extent at pathologic examination, reflecting
the effectiveness of the preoperative treatment. Survival and
recurrence-free survival in the two treatment groups were also taken into
account. The stage distribution was comparable in the two groups, with 52%
stage I tumors in group R, and 43% in group C. Significant changes in the
pathologic pattern were more frequent in group R than in group C (53%
versus 17%). From these data it is concluded that preoperative chemotherapy
is as good as preoperative radiotherapy in terms of prevention of tumor
rupture. In addition, it was shown that 43% of an unselected population of
patients with Wilms' tumor could be treated without any radiotherapy when
chemotherapy had been given preoperatively.
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