This proposal is to study the long term health of children treated for Wilms tumor (WT), and to monitor their offspring for cancer and birth defects. The study is based in the unique and well described cohort of 9,236 patients enrolled during 1969-2002 on one of 5 clinical trials conducted by the National Wilms Tumor Study (NWTS). NWTS studies 3-5 developed treatment protocols that today are administered as standard therapy to the vast majority of patients. With this therapy, 90% of children with WT are cured. Survivors, however, are at risk for delayed complications of their disease or its treatment that may compromise their quality of life. Since the disease typically occurs in early childhood, many decades of follow-up are required to appreciate the consequences for adult survivors. Four life-threatening conditions are targeted: secondary malignant neoplasms; congestive heart failure; end stage renal disease (ESRD); and restrictive pulmonary disease. Most occurrences are validated by examination of medical records. Specific goals are to identify new subgroups of patients from NWTS-3-5 at high risk for each condition based on treatment, disease and host factors. Patients at high risk for ESRD, for example, may be considered for renal sparing surgery. Biological samples collected from patients on NWTS-5 will be used to test the hypothesis that mutations in the WT1 gene not only predispose to WT in childhood but also to ESRD in adolescence and adulthood. Systematically collected information on birth weights, congenital anomalies, nephrogenic rests, histologic type, and on radiation and chemotherapy doses will be used to construct risk functions for ESRD and to investigate whether treatment effects on congestive heart failure and secondary malignant neoplasms differ according to the biological subtype of Wilms tumor. The study will estimate rates of ovarian failure in female patients and rates of live birth and risks of pregnancy complications in partners of male patients. Heritability and recurrence risks of WT, together with the frequency of birth defects in the next generation, will be estimated through follow-up of a unique cohort of patient offspring.

Public Health Relevance

By elucidating the late complications of WT and its treatment, and by identifying susceptible subgroups, this study will enable future generations of childhood cancer patients and their physicians to select optimum treatments based on knowledge of long term risks as well as short term benefits. It will assist survivors to make informed decisions regarding the risks of pregnancy and the likelihood that their children will also develop Wilms tumor or birth defects.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Epidemiology of Cancer Study Section (EPIC)
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Elena, Joanne W
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Fred Hutchinson Cancer Research Center
United States
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Mullen, Elizabeth A; Chi, Yueh-Yun; Hibbitts, Emily et al. (2018) Impact of Surveillance Imaging Modality on Survival After Recurrence in Patients With Favorable-Histology Wilms Tumor: A Report From the Children's Oncology Group. J Clin Oncol :JCO1800076
Venkatramani, Rajkumar; Chi, Yueh-Yun; Coppes, Max J et al. (2017) Outcome of patients with intracranial relapse enrolled on national Wilms Tumor Study Group clinical trials. Pediatr Blood Cancer 64:
Gratias, Eric J; Dome, Jeffrey S; Jennings, Lawrence J et al. (2016) Association of Chromosome 1q Gain With Inferior Survival in Favorable-Histology Wilms Tumor: A Report From the Children's Oncology Group. J Clin Oncol 34:3189-94
Feijen, Elizabeth A M; Leisenring, Wendy M; Stratton, Kayla L et al. (2015) Equivalence Ratio for Daunorubicin to Doxorubicin in Relation to Late Heart Failure in Survivors of Childhood Cancer. J Clin Oncol 33:3774-80
Breslow, Norman E; Peterson, Susan M; Green, Daniel M (2015) Reply to Wilms tumor and breast cancer. Cancer 121:2099-100
Chow, Eric J; Chen, Yan; Kremer, Leontien C et al. (2015) Individual prediction of heart failure among childhood cancer survivors. J Clin Oncol 33:394-402
Lange, Jane M; Takashima, Janice R; Peterson, Susan M et al. (2014) Breast cancer in female survivors of Wilms tumor: a report from the national Wilms tumor late effects study. Cancer 120:3722-30
Maschietto, Mariana; Williams, Richard D; Chagtai, Tasnim et al. (2014) TP53 mutational status is a potential marker for risk stratification in Wilms tumour with diffuse anaplasia. PLoS One 9:e109924
Green, Daniel M; Breslow, Norman E; D'Angio, Giulio J et al. (2014) Outcome of patients with Stage II/favorable histology Wilms tumor with and without local tumor spill: a report from the National Wilms Tumor Study Group. Pediatr Blood Cancer 61:134-9
Malogolowkin, M; Spreafico, F; Dome, J S et al. (2013) Incidence and outcomes of patients with late recurrence of Wilms' tumor. Pediatr Blood Cancer 60:1612-5

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