The treatment of Wilms' tumor. Results of the national Wilms' tumor study
The treatment of Wilms' tumor. Results of the national Wilms' tumor study
复制标题
维尔姆斯氏瘤的治疗。
作者：
G. D'angio;A. Evans;N. Breslow;B. Beckwith;H. Bishop;P. Feigl;W. Goodwin;L. Leape;L. Sinks;W. Sutow;M. Tefft;J. Wolff
1969年开始的国家Wilms肿瘤研究测试了从第I组（肿瘤局限于肾脏并完全切除）到第IV组（诊断时存在远处转移）的肿瘤患者的竞争治疗策略。606例登记患者中有359例在试验中接受了随机化。2岁以下的GP I患者无论术后放疗（RT）是否加用15个月的维持性放线菌素D（AMD），均表现良好。他们的预后优于接受类似治疗的老年队列，其中治疗组之间复发率的差异提示RT效应。AMD和长春新碱（VCR）联合治疗仍局限于腹部的晚期肿瘤（Gps II和III）患者的结果优于单独使用任何一种药物，所有患者均接受了术后RT。术前给予Gp IV的VCR患者，加上术后RT、AMD和VCR未改善结果。中胚层肾瘤（1%），双侧肿瘤（5%），和不正确的术前诊断的肾母细胞瘤（5%），各种方案的毒性，和其他辅助数据的频率进行了介绍和讨论。
The National Wilms' Tumor Study, initiated in 1969, tested competing treatment strategems for patients with tumors ranging from Group (Gp) I (tumors confined to the kidney and totally removed) to Gp IV (remote metastases present at diagnosis). Three hundred and fifty‐nine of 606 registered patients were randomized in the trial. Gp I patients under 2 years of age fared well whether postoperative radiation therapy (RT) was or was not added to 15 months' maintenance actinomycin D (AMD). Their prognosis was better than that for older cohorts similarly treated, in whom the difference in relapse rates between treatment groups were suggestive of an RT effect. Combined AMD and vincristine (VCR) gave better results than either agent alone in patients with more advanced tumors (Gps II and III) still confined to the abdomen, all of whom received postoperative RT as well. Preoperative VCR given Gp IV patients in addition to postoperative RT, AMD, and VCR did not improve results. The frequency of mesoblastic nephroma (1%), of bilateral tumors (5%), and of incorrect preoperative diagnosis of Wilms' tumor (5%), the toxicities of the various regimens, and other ancillary data are presented and discussed.