ABSTRACT
PURPOSE: To evaluate the effect of whole lung radiotherapy on event-free and overall survival of children with Stage IV Wilms' tumor with pulmonary metastases at diagnosis and to ascertain factors that may have led to the decision to withhold radiotherapy. METHODS AND MATERIALS: We compared recurrence and mortality risks of patients with pulmonary metastases at diagnosis enrolled in the UKW2 and UKW3 clinical trials (1986-2001) according to treatment with pulmonary radiotherapy. RESULTS: Of 102 eligible patients (43 patients in UKW2 and 59 patients in UKW3), 72 (71%) received pulmonary radiotherapy; 30 (29%) did not. After a median follow-up of 9.3 years (range, 0.6-14.1 years), event-free survival was 79.2% (95% confidence interval [CI], 67.8-86.9%) in patients who received pulmonary radiotherapy compared with 53.3% (95% CI, 34.3-69.1%) in patients who did not receive it (p = 0.006), with a hazard ratio of 2.66 (95% CI, 1.28-5.52; p = 0.009). There was no difference in overall survival (84.7% [95% CI, 74.1-91.2%] vs. 73.2% [95% CI, 53.4-85.6%], respectively; p = 0.157). Pulmonary radiotherapy reduced the chance of lung relapse (8.3% vs. 23.3%; p = 0.039). The omission of radiotherapy did not seem to be consistently associated with any specific clinical or radiologic features. CONCLUSIONS: Outcome may be compromised if pulmonary radiotherapy is omitted in children with Wilms' tumor with pulmonary metastases. There was a significant effect on event-free survival; the risk of an event, particularly lung recurrence, was increased nearly threefold. Strategies for selection of children for avoidance of pulmonary irradiation need to be developed in a controlled fashion.
Subject(s)
Kidney Neoplasms , Lung Neoplasms/radiotherapy , Wilms Tumor/radiotherapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Child , Child, Preschool , Confidence Intervals , Disease-Free Survival , Female , Follow-Up Studies , Humans , Infant , Kidney Neoplasms/mortality , Kidney Neoplasms/pathology , Lung Neoplasms/drug therapy , Lung Neoplasms/mortality , Lung Neoplasms/secondary , Male , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Radiotherapy Dosage , Refusal to Treat , Retrospective Studies , Wilms Tumor/drug therapy , Wilms Tumor/mortality , Wilms Tumor/secondaryABSTRACT
Antilock braking systems (ABS) are fitted to many new cars with the aims of improving their ability to steer while braking heavily and of reducing stopping distances on some road surfaces. This paper presents the findings of a project that assessed the effectiveness of ABS in reducing accidents in Great Britain. A large postal survey was carried out of the owners of modern cars. asking for details of any accidents in which they had been involved during the previous year as well as factors that might influence their likelihood of being involved in an accident. Questions were also asked to test respondents' knowledge of ABS. ABS cars ditfered in several respects from non-ABS cars, as did the two groups of drivers. Consequently, a sophisticated statistical analysis was required to provide unbiased estimates of the effectiveness of ABS. Various results did not achieve statistical significance, but the overall stability of the results indicates that real effects have been measured. They confirm that ABS does have the potential to reduce the number of accidents, but show that this has not been fully achieved. One reason may be that many drivers have little or no knowledge of ABS.
