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Late Health Outcomes Among Survivors of Wilms Tumor Diagnosed Over Three Decades: A Report From the Childhood Cancer Survivor Study.

Publication ,  Journal Article
Weil, BR; Murphy, AJ; Liu, Q; Howell, RM; Smith, SA; Weldon, CB; Mullen, EA; Madenci, AL; Leisenring, WM; Neglia, JP; Turcotte, LM; Levine, JM ...
Published in: J Clin Oncol
May 10, 2023

PURPOSE: To evaluate long-term morbidity and mortality among unilateral, nonsyndromic Wilms tumor (WT) survivors according to conventional treatment regimens. METHODS: Cumulative incidence of late mortality (≥ 5 years from diagnosis) and chronic health conditions (CHCs) were evaluated in WT survivors from the Childhood Cancer Survivor Study. Outcomes were evaluated by treatment, including nephrectomy combined with vincristine and actinomycin D (VA), VA + doxorubicin + abdominal radiotherapy (VAD + ART), VAD + ART + whole lung radiotherapy, or receipt of ≥ 4 chemotherapy agents. RESULTS: Among 2,008 unilateral WT survivors, 142 deaths occurred (standardized mortality ratio, 2.9, 95% CI, 2.5 to 3.5; 35-year cumulative incidence of death, 7.8%, 95% CI, 6.3 to 9.2). The 35-year cumulative incidence of any grade 3-5 CHC was 34.1% (95% CI, 30.7 to 37.5; rate ratio [RR] compared with siblings 3.0, 95% CI, 2.6 to 3.5). Survivors treated with VA alone had comparable risk for all-cause late mortality relative to the general population (standardized mortality ratio, 1.0; 95% CI, 0.5 to 1.7) and modestly increased risk for grade 3-5 CHCs compared with siblings (RR, 1.5; 95% CI, 1.1 to 2.0), but remained at increased risk for intestinal obstruction (RR, 9.4; 95% CI, 3.9 to 22.2) and kidney failure (RR, 11.9; 95% CI, 4.2 to 33.6). Magnitudes of risk for grade 3-5 CHCs, including intestinal obstruction, kidney failure, premature ovarian insufficiency, and heart failure, increased by treatment group intensity. CONCLUSION: With approximately 40% of patients with newly diagnosed WT currently treated with VA alone, the burden of late mortality/morbidity in future decades is projected to be lower than that for survivors from earlier eras. Nevertheless, the risk of late effects such as intestinal obstruction and kidney failure was elevated across all treatment groups, and there was a dose-dependent increase in risk for all grade 3-5 CHCs by treatment group intensity.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

May 10, 2023

Volume

41

Issue

14

Start / End Page

2638 / 2650

Location

United States

Related Subject Headings

  • Wilms Tumor
  • Survivors
  • Outcome Assessment, Health Care
  • Oncology & Carcinogenesis
  • Neoplasms
  • Kidney Neoplasms
  • Intestinal Obstruction
  • Humans
  • Chronic Disease
  • Child
 

Citation

APA
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Weil, B. R., Murphy, A. J., Liu, Q., Howell, R. M., Smith, S. A., Weldon, C. B., … Armenian, S. H. (2023). Late Health Outcomes Among Survivors of Wilms Tumor Diagnosed Over Three Decades: A Report From the Childhood Cancer Survivor Study. J Clin Oncol, 41(14), 2638–2650. https://doi.org/10.1200/JCO.22.02111
Weil, Brent R., Andrew J. Murphy, Qi Liu, Rebecca M. Howell, Susan A. Smith, Christopher B. Weldon, Elizabeth A. Mullen, et al. “Late Health Outcomes Among Survivors of Wilms Tumor Diagnosed Over Three Decades: A Report From the Childhood Cancer Survivor Study.J Clin Oncol 41, no. 14 (May 10, 2023): 2638–50. https://doi.org/10.1200/JCO.22.02111.
Weil BR, Murphy AJ, Liu Q, Howell RM, Smith SA, Weldon CB, et al. Late Health Outcomes Among Survivors of Wilms Tumor Diagnosed Over Three Decades: A Report From the Childhood Cancer Survivor Study. J Clin Oncol. 2023 May 10;41(14):2638–50.
Weil, Brent R., et al. “Late Health Outcomes Among Survivors of Wilms Tumor Diagnosed Over Three Decades: A Report From the Childhood Cancer Survivor Study.J Clin Oncol, vol. 41, no. 14, May 2023, pp. 2638–50. Pubmed, doi:10.1200/JCO.22.02111.
Weil BR, Murphy AJ, Liu Q, Howell RM, Smith SA, Weldon CB, Mullen EA, Madenci AL, Leisenring WM, Neglia JP, Turcotte LM, Oeffinger KC, Termuhlen AM, Mostoufi-Moab S, Levine JM, Krull KR, Yasui Y, Robison LL, Armstrong GT, Chow EJ, Armenian SH. Late Health Outcomes Among Survivors of Wilms Tumor Diagnosed Over Three Decades: A Report From the Childhood Cancer Survivor Study. J Clin Oncol. 2023 May 10;41(14):2638–2650.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

May 10, 2023

Volume

41

Issue

14

Start / End Page

2638 / 2650

Location

United States

Related Subject Headings

  • Wilms Tumor
  • Survivors
  • Outcome Assessment, Health Care
  • Oncology & Carcinogenesis
  • Neoplasms
  • Kidney Neoplasms
  • Intestinal Obstruction
  • Humans
  • Chronic Disease
  • Child