Twenty-five year follow-up of childhood Wilms tumor: A report from the Childhood Cancer Survivor Study

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Abstract

Background.

Treatment cures over 90% of children with Wilms tumor (WT) who subsequently risk late morbidity and mortality. This study describes the 25-year outcomes of 5-year WT survivors in the Childhood Cancer Survivor Study (CCSS).

Procedure.

The CCSS, a multi-institutional retrospective cohort study, assessed WT survivors (N = 1,256), diagnosed 1970–1986, for chronic health conditions, health status, health care utilization, socioeconomic status, subsequent malignant neoplasms (SMNs), and mortality compared to the US population and a sibling cohort (N = 4,023).

Results.

The cumulative incidence of all and severe chronic health conditions was 65.4% and 24.2% at 25 years. Hazard ratios (HR) were 2.0, 95% confidence interval (CI) 1.8–2.3 for grades 1–4 and 4.7, 95%CI 3.6–6.1 for grades 3 and 4, compared to sibling group. WT survivors reported more adverse general health status than the sibling group (prevalence ratio [PR] 1.7; 95%CI 1.2–2.4), but mental health status, socioeconomic outcome, and health care utilization were similar. The cumulative incidence of SMN was 3.0% (95%CI 1.9–4.0%) and of mortality was 6.1% (95%CI 4.7–7.4%). Radiation exposure increased the likelihood of congestive heart failure (CHF) (no doxorubicin—HR 6.6; 95%CI 1.6–28.3; doxorubicin ≤250 mg/m2—HR 13.0; 95%CI 1.9–89.7; doxorubicin >250 mg/m2—HR 18.3; 95%CI 3.8–88.2), SMN (standardized incidence ratio [SIR] 9.0; 95%CI 3.9–17.7 with and 4.9; 95%CI 1.8–10.6 without doxorubicin) and death.

Conclusion.

Long-term survivors of WT treated from 1970 to 1986 are at increased risk of treatment related morbidity and mortality 25 years from diagnosis. Pediatr Blood Cancer 2011; 57: 1210–1216. © 2011 Wiley Periodicals, Inc.

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