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

Cancer Research UK

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 per cent 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."

ENDS

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Notes to Editor

*Immediate nephrectomy versus pre-operative chemotherapy in the management of non-metastatic Wilms’ Tumour; Results of a Randomised Trial (UKW3) by the UK Children’s Cancer Study Group. Christopher Mitchell et al. (2006). European Journal of Cancer.

This study was supported by a grant to the UK Children’s Cancer Study Group from Cancer Research UK. Wilms’ tumours

Wilms’ tumours, also known as nephroblastomas, are a type of kidney cancer that affects children. Kidney cancer in children is rare but this is the most common type they can get. More than 9 out of 10 kidney cancers (95 per cent) found in children are Wilms' tumours. Wilms’ tumours usually only affect one kidney (unilateral) but in about 7 out of every 100 children (7 per cent) it can affect both (bilateral).

**The Children’s Cancer and Leukaemia Group

Cancer Research UK is the major funding provider of the Children's Cancer and Leukaemia Group (formally the UK Children's Cancer Study Group) and funds the UK clinical trials work of the group via its coordinating centre in Leicester and 22 paediatric centres throughout the British Isles.

The Children's Cancer and Leukaemia Group is the national professional body responsible for the organisation, treatment and management of virtually all children with cancer in the UK. The group is acknowledged as one of the world's leading childhood cancer clinical trial groups and over the past five years there has been significant progress and success in its trials, resulting in improvements in survival.

Cancer Research UK is the largest supporter of research into children's cancer in the UK. The charity is committed to improving survival and quality of life for every child with cancer.

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About the NCRI

The National Cancer Research Institute (NCRI) was established in April 2001. It is a partnership between government, the voluntary sector and the private sector, with the primary mission of maximising patient benefit that accrues from cancer research in the UK through coordination of effort and joint planning towards an integrated national strategy for cancer research. Click here to visit the NCRI website.

The NCRI consists of: The Association of British Pharmaceutical Industry (ABPI); The Association for International Cancer Research; The Biotechnology and Biological Sciences Research Council; Breakthrough Breast Cancer; Breast Cancer Campaign; Cancer Research UK; Department of Health; Economic and Social Research Council; Leukaemia Research Fund; Ludwig Institute for Cancer Research; Macmillan Cancer Support; Marie Curie Cancer Care; The Medical Research Council; Northern Ireland Health and Personal Social Services Research & Development Office; Roy Castle Lung Cancer Foundation; Scottish Executive Health Department; Tenovus; Wales Office of Research and Development for Health & Social Care; Wellcome Trust; and Yorkshire Cancer Research. AstraZeneca is the gold sponsor for the NCRI Cancer Conference 2006.