Shorter courses of chemotherapy for children with Wilms’ tumour most beneficial

Results of a European study in this week’s issue of THE LANCET suggest that shorter courses of chemotherapy for children with Wilms’ tumour may be as effective as conventional treatment duration, but have the advantage of reduced toxicity and health-care costs.

Wilms’ tumour, a kidney cancer in under 15-year-olds, affects around 5 children per million every year. Current treatment for this disease (involving chemotherapy and surgical tumour removal) is very successful; efforts are now aimed at reducing toxicity and burden of treatment by shortening the duration of postoperative chemotherapy without loss of effectiveness.

Jan de Kraker (Academic Medical Centre, University of Amsterdam, and colleagues on behalf of the International Society of Paediatric Oncology studied 410 children (aged 6 months to 18 years) who were randomly assigned either 4 weeks or 18 weeks chemotherapy after surgery to remove kidney tumour and preoperative chemotherapy.

After two years follow-up, there was no statistical difference in disease recurrence between the two groups (18 in the standard 18-week postoperative chemotherapy group), 22 in the experimental 4-week chemotherapy group). Similarly, there was no overall difference in two-year survival, which was around 90% in both groups.

Dr de Kraker comments: “Shortening duration of chemotherapy could reduce acute and late side-effects and inconvenience for patient and parents while maintaining effectiveness, and could be beneficial in terms of health costs”.

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