Congestive Heart Failure After Treatment for Wilms' Tumor: A report from the National Wilms' Tumor Study Group
Daniel M. Green, Yevgeny A. Grigoriev, Bin Nan, Janice R. Takashima, Pat A. Norkool, Guilio J. D'Angio, and Norman E. Breslow
Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 1, 2001
Reviewers: Li Liu, MD
Source: Journal of Clinical Oncology, Vol 19, Issue 7 (April), 2001: 1926-1934
The prognosis for children with Wilms' tumor
has improved dramatically during the past three decades. The purpose of this study was to examine the frequency of and risk factors for congestive heart failure (CHF) in patients whose treatment included doxorubicin
on the National Wilms' Tumor Studies (NWTS) -1, -2, -3, and -4, and to evaluate other possible risk factors for the occurrence of CHF. CHF was considered to have occurred if the patient required treatment with digoxin and diuretics.
The NWTS were multi-institutional randomized trials for different treatment regimens for patients who were younger than 16 years of age at diagnosis with Wilms' tumor. Flow sheets and medical records were reviewed to identify cases of CHF in this cohort of patients. A case-control study was conducted to determine the relationship among cumulative doxorubicin dose, site(s) and total dose of abdominal and thoracic irradiation, gender, and frequency of CHF.
Results and Discussion
The researchers identified CHF as a significant morbidity in children treated with doxorubicin and thoracic or left abdominal irradiation for Wilms' tumor. Female patients were at greater risk for CHF than male patients, and former patients should be told of their risk for developing cardiac disease. These patients should be monitored closely by a cardiologist prior to the initiation of a vigorous program of physical activity or getting pregnant.