Date Published: 10 October 2006

Postponing surgery reduces long term side effects for children with kidney cancer

Children given chemotherapy before surgery to treat the most common form of childhood kidney cancer, called Wilms’ tumour, require less treatment and experience fewer long term side effects than if they have immediate surgery, according to trial results revealed at today’s NCRI Cancer Conference and published in the European Journal of Cancer.

The Children’s Cancer and Leukaemia Group (CCLG), funded by Cancer Research UK, undertook a ten-year trial involving 205 patients with newly diagnosed Wilms’ tumours. The patients were randomly assigned to receive either immediate surgery or six weeks pre-operative chemotherapy and then surgery. Depending on the size of their tumours and how much they had grown, all children on the trial were given chemotherapy, radiotherapy or both after their surgery to kill off any remaining cancer cells.

Overall survival between the two groups was the same, but the researchers found that giving six weeks pre-operative chemotherapy enabled easier removal of tumours. Also, 20% fewer children needed radiotherapy or the powerful chemotherapy drug doxorubicin after their surgery, minimising their risk of long-term side effects. The results of this trial are strong enough to conclude that pre-operative chemotherapy should be become standard for the treatment of Wilms’ tumours throughout the UK.

Around 78 children in the UK are diagnosed with Wilms’ tumour each year and it is the most common type of kidney cancer that children can get. Wilms’ tumours are most likely to occur in children under five - they can appear in older children and adults but this is rare. Wilms’ tumour is one of the most curable childhood cancers with nine out of ten children being cured in the long term.

The purpose of this trial was to see if doctors could avoid giving children radiotherapy and the powerful chemotherapy doxorubicin if they did not need it. Giving radiotherapy to the kidneys of young children can be damaging because the kidneys are situated close to the spine and the effects of the radiotherapy can stunt growth and sometimes lead to spinal deformities. Doxorubicin is used to treat children with more advanced tumours, but it may cause heart problems later in life.

Study author Dr Christopher Mitchell, from the Oxford Radcliffe Hospital, said:

" Deciding what is the best way to treat Wilms’ tumours has been under debate for many years and this study was the first time that the two treatment methods were compared in a randomised clinical trial. We were able to identify a group of patients who could benefit from a reduction in treatment without compromising their survival chances. For some children with advanced tumours, delaying their surgery reduced the size of their tumours enough to prevent them needing intensive treatment after surgery. This improvement in quality of life for patients is significant and we hope children diagnosed with Wilms’ tumours in the future will benefit from our findings."

Kate Law, Cancer Research UK’s director of clinical trials, said:

" These are significant results that have led to a change in the way children in the UK are treated for this disease. As more children survive this type of cancer, anything that adds to our understanding of how to reduce the long-term side effects of the treatment is important work."

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