Significance and management of computed tomography detected pulmonary nodules: A report from the National Wilms Tumor Study Group
Significance and management of computed tomography detected pulmonary nodules: A report from the National Wilms Tumor Study Group
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DOI：
10.1016/s0360-3016(99)00086-3
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发表时间：
1999-06-01
影响因子：
7
通讯作者：
Green, DM
中科院分区：
文献类型：
--
作者：
Meisel, JA;Guthrie, KA;Green, DM
目的：为了确定胸部计算机断层扫描（CT）发现肺结节但胸片阴性的肾母细胞瘤患儿的最佳治疗方法，我们评估了所有随机分组或国家肾母细胞瘤研究（NWTS）-3和-4随访的此类患者的结局。患者和方法：我们估计了53例仅通过CT扫描（仅CT）确定的组织学肿瘤和肺密度良好的患者的无事件和总生存率这些患者接受了IV期强化阿霉素化疗和全肺放疗，并将其与37例仅接受CT治疗的患者的无事件和总生存率进行了比较，这些患者根据局部疾病的程度采用2种或3种药物进行了较低程度的治疗，并且没有进行全肺放疗。53例仅CT结节和良好组织学Wilms肿瘤患者接受IV期治疗的4年无事件和总生存率分别为89%和91%。根据局部病变程度进行治疗的37例仅CT结节和组织学良好的患者的4年无事件和总生存率分别为80%和85%。两组间观察到的差异无统计学显著性。在接受全肺照射的患者中，肺部复发较少，但更多的死亡归因于肺toxicity.Conclusions：目前的数据提出的可能性，肾母细胞瘤和CT仅肺结节的儿童接受全肺照射有较少的肺部复发，但更多的死亡，由于治疗毒性。根据目前的数据，不能明确确定全肺照射在这组患者治疗中的作用。对这组患者进行长期随访是准确估计晚期治疗相关死亡率频率所必需的。(C)1999 Elsevier Science Inc.
Purpose: To define the optimal treatment for children with Wilms tumor who have pulmonary nodules identified on chest computed tomography (CT) scan, but have a negative chest radiograph, we evaluated the outcome of all such patients randomized or followed on National Wilms Tumor Study (NWTS)-3 and -4,Patients and Methods: We estimated the event-free and overall survival percentages of 53 patients with favorable histology tumors and pulmonary densities identified only by CT scan (CT-only) who were treated as Stage IV with intensive doxorubicin-containing chemotherapy and whole-lung irradiation, and compared these to the event-free and overall survival percentages of 37 CT-only patients who were treated less aggressively based on the extent of locoregional disease with 2 or 3 drugs, and without whole-lung irradiation.Results: The 4-year event-free and overall survival percentages of the 53 patients with CT-only nodules and favorable histology Wilms tumor who were treated as Stage IV were 89% and 91%, respectively. The 4-year event-free and overall survival percentages for the 37 patients with CT-only nodules and favorable histology who were treated according to the extent of locoregional disease were 80% and 85%, respectively. The differences observed between the 2 groups were not statistically significant. Among the patients who received whole-lung irradiation, there were fewer pulmonary relapses, but more deaths attributable to lung toxicity.Conclusions: The current data raise the possibility that children with Wilms tumor and CT-only pulmonary nodules who receive whole lung irradiation have fewer pulmonary relapses, but a greater number of deaths due to treatment toxicity. The role of whole lung irradiation in the treatment of this group of patients cannot be definitively determined based on the present data. Prolonged follow-up of this group of patients is necessary to accurately estimate the frequency of late, treatment-related mortality. (C) 1999 Elsevier Science Inc.