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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Treatment regimens for Wilms tumor according to completed North American (COG) protocols

Treatment regimens for Wilms tumor according to completed North American (COG) protocols
COG AREN0321, AREN0532, and AREN0533
Stage* Histology and clinical factors Chemotherapy Radiation therapy
I Favorable histology; very low risk None None
Favorable histology; non-very low risk; without high-risk molecular markersΔ Vincristine and dactinomycin for 19 weeks None
Favorable histology; non-very low risk; with high-risk molecular markersΔ Vincristine, dactinomycin, and doxorubicin for 25 weeks None
Focal or diffuse anaplasia Vincristine, dactinomycin, and doxorubicin for 25 weeks 10.8 Gy flank
II Favorable histology; without high-risk molecular markersΔ Vincristine and dactinomycin for 19 weeks None
Favorable histology; with high-risk molecular markersΔ Vincristine, dactinomycin, and doxorubicin for 25 weeks None
Focal anaplasia Vincristine, dactinomycin, and doxorubicin for 25 weeks 10.8 Gy flank
Diffuse anaplasia Vincristine, doxorubicin, carboplatin, cyclophosphamide, and etoposide for 30 weeks 10.8 Gy flank
III Favorable histology; without high-risk molecular markersΔ Vincristine, dactinomycin, and doxorubicin for 25 weeks 10.8 Gy flank/abdomen; 10.8 Gy boost for gross disease
Favorable histology; with high-risk molecular markersΔ Vincristine, dactinomycin, doxorubicin, cyclophosphamide, and etoposide for 31 weeks 10.8 Gy flank/abdomen; 10.8 Gy boost for gross disease
Focal anaplasia Vincristine, dactinomycin, and doxorubicin for 25 weeks 10.8 Gy flank/abdomen; 10.8 Gy boost for gross disease
Diffuse anaplasia Vincristine, doxorubicin, carboplatin, cyclophosphamide, and etoposide for 30 weeks 20 Gy flank/abdomen; 10.8 Gy boost for gross disease
IV Favorable histology; without high-risk molecular markersΔ and lung nodule complete response at week 6 Vincristine, dactinomycin, and doxorubicin for 25 weeks No lung XRT; flank XRT for local stage III◊
Favorable histology; with high-risk molecular markersΔ and/or lung nodule incomplete response at week 6 Vincristine, dactinomycin, doxorubicin, cyclophosphamide, and etoposide for 31 weeks 12 Gy lung; flank XRT for local stage III◊
Focal anaplasia Vincristine, doxorubicin, carboplatin, cyclophosphamide, and etoposide for 30 weeks 12 Gy lung; flank XRT for local stage III◊
Diffuse anaplasia Vincristine, doxorubicin, carboplatin, cyclophosphamide, etoposide, and irinotecan for 36 weeks 12 Gy lung; flank XRT for local stage III◊
COG: Children's Oncology Group; SIOP: International Society of Paediatric Oncology; XRT: radiation therapy.
* Note that the staging systems in COG and SIOP protocols are not equivalent. COG stage is determined before surgical resection; SIOP stage is determined after preoperative chemotherapy and surgical resection.
¶ According to COG protocols, very low-risk tumors are defined as meeting all of the following criteria: patient age <2 years, stage I favorable histology, tumor weight <550 g.
Δ According to COG protocols, high-risk molecular markers refers to combined loss of heterozygosity at chromosomes 1p and 16q.
◊ Metastatic sites other than lung were also irradiated; XRT dose varied according to metastatic site.
Additional references:
  1. Fernandez CV, Perlman EJ, Mullen EA, et al. Clinical outcome and biological predictors of relapse after nephrectomy only for very low-risk Wilms tumor: A report From Children's Oncology Group AREN0532. Ann Surg 2017; 265:835.
  2. Dix DB, Fernandez CV, Chi YY, et al. Augmentation of therapy for favorable-histology Wilms Tumor with combined loss of heterozygosity of chromosomes 1p and 16q: A report from the Children's Oncology Group studies AREN0532 and AREN0533. J Clin Oncol 2015; 33:abstr 10009.
  3. Fernandez CV, Mullen EA, Chi YY, et al. Outcome and prognostic factors in stage III favorable-histology Wilms tumor: A report from the Children's Oncology Group Study AREN0532. J Clin Oncol 2018; 36:254.
  4. Dix DB, Seibel NL, Chi YY, et al. Treatment of stage IV favorable histology Wilms tumor with lung metastases: A report from the Children's Oncology Group AREN0533 Study. J Clin Oncol 2018; 36:1564.
Adapted from: Dome JS, Graf N, Geller JI, et al. Advances in Wilms tumor treatment and biology: Progress through international collaboration. J Clin Oncol 2015; 33:2999.
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