Relapsed Wilms tumor - Is there a role for radiation therapy?

From 1968 to 1996, 21 of 97 (22%) patients with Wilms tumor treated at the University of Iowa Hospitals and Clinics relapsed after initial therapy. Th e most common sites of initial recurrence were the lungs in 12 (57%), abdom en in 3 (14%), bone in 3 (14%), and liver in 2 (10%). Treatment for recurre nce included chemotherapy in 16, radiotherapy in 15 and surgery in 8. Radio therapy was given to bilateral lungs of 8 previously untreated chests; tota l dose was 1,200 cGy to 1,500 cGy, with 2 patients receiving 1,000-cGy boos t. One patient had abdominal radiotherapy after surgery for relapse; six pa tients had palliative radiotherapy to distant sites. The 1-, 3-, and 5-year postrelapse survivals were 62 +/- 11%, 38 +/- 11%, and 33 +/- 410%, respec tively. Using Cox proportional-hazard regression models, abdominal recurren ce (p = 0.0002; hazard ratio, 39.5) and initial stage IV disease (p = 0.019 ; hazard ratio, 6.27) were found to have a negative impact on postrelapse s urvival. Seven patients with previously nonirradiated chests are alive at a median follow-up of 123 months after relapse (range, 55-272 months); all h ad whole lung irradiation with or without chemotherapy at relapse for lung metastases. Radiotherapy was also found to be an effective treatment in the palliation of painful metastases.