Congestive heart failure after treatment for Wilms' tumor: A report from the National Wilms' Tumor Study Group

Purpose: We determined the frequency of and risk factors for congestive hea rt failure following treatment for Wilms' tumor that included doxorubicin. Patients and Methods: Flow sheets and medical records were reviewed to iden tify cases of congestive heart failure in a cohort of patients treated on N ational Wilms' Tumor Studies (NWTS)-1, -2, -3, and -4. The frequency of con gestive heart failure was estimated using the Kaplan-Meier method. A case-c ontrol study was conducted to determine the relationship among cumulative d oxorubicin dose, site(s), total dose of abdominal and thoracic irradiation, sex, and the frequency of congestive heart failure. Results: The cumulative frequency of congestive heart failure was 4.4% at 2 0 years after diagnosis among patients treated initially with doxorubicin a nd 17.4% at 20 years after diagnosis among those treated with doxorubicin f or their first or subsequent relapse of Wilms' tumor. The relative risk (RR ) of congestive heart failure was increased in females (RR = 4.5; P = .004) and by cumulative doxorubicin dose (RR = 3.3/100 mg/m(2); P < .001), lung irradiation (RR = 1.6/10 Gy; P = .037), and left abdominal irradiation (RR = 1.8/10 Gy; P = .013). Conclusion: We conclude that congestive heart failure is a risk of treatmen t with doxorubicin for Wilms' tumor. Additional follow-up of those children treated on NWTS-4 will be necessary to determine if the decrease in dose t o 150 mg/m(2) significantly reduces this risk. <(c)> 2001 by American Socie ty of Clinical Oncology.