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An international strategy to determine the role of high dose therapy in recurrent Wilms' tumour

Journal Article


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.

UOW Authors


  •   Ha, Tam
  •   Spreafico, Filippo (external author)
  •   Graf, Norbert (external author)
  •   Dallorso, Sandro (external author)
  •   Dome, Jeffrey S. (external author)
  •   Malogolowkin, Marcio (external author)
  •   Furtwängler, Rhoikos (external author)
  •   Hale, Juliet P. (external author)
  •   Moroz, Veronica (external author)
  •   MacHin, David (external author)
  •   Pritchard-Jones, Kathy (external author)

Publication Date


  • 2013

Citation


  • Ha, T. C., Spreafico, F., Graf, N., Dallorso, S., Dome, J. S., Malogolowkin, M., Furtwängler, R., Hale, J. P., Moroz, V., Machin, D. & Pritchard-Jones, K. (2013). An international strategy to determine the role of high dose therapy in recurrent Wilms' tumour. European Journal of Cancer, 49 (1), 194-210.

Scopus Eid


  • 2-s2.0-84871435281

Has Global Citation Frequency


Number Of Pages


  • 16

Start Page


  • 194

End Page


  • 210

Volume


  • 49

Issue


  • 1

Place Of Publication


  • United Kingdom

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.

UOW Authors


  •   Ha, Tam
  •   Spreafico, Filippo (external author)
  •   Graf, Norbert (external author)
  •   Dallorso, Sandro (external author)
  •   Dome, Jeffrey S. (external author)
  •   Malogolowkin, Marcio (external author)
  •   Furtwängler, Rhoikos (external author)
  •   Hale, Juliet P. (external author)
  •   Moroz, Veronica (external author)
  •   MacHin, David (external author)
  •   Pritchard-Jones, Kathy (external author)

Publication Date


  • 2013

Citation


  • Ha, T. C., Spreafico, F., Graf, N., Dallorso, S., Dome, J. S., Malogolowkin, M., Furtwängler, R., Hale, J. P., Moroz, V., Machin, D. & Pritchard-Jones, K. (2013). An international strategy to determine the role of high dose therapy in recurrent Wilms' tumour. European Journal of Cancer, 49 (1), 194-210.

Scopus Eid


  • 2-s2.0-84871435281

Has Global Citation Frequency


Number Of Pages


  • 16

Start Page


  • 194

End Page


  • 210

Volume


  • 49

Issue


  • 1

Place Of Publication


  • United Kingdom