Treatment results among adults with childhood tumors: A 20-year experience

doi:10.1016/0360-3016(89)90101-6

International Journal of Radiation OncologyBiologyPhysics

Volume 17, Issue 3, September 1989, Pages 507-514

https://doi.org/10.1016/0360-3016(89)90101-6 Get rights and content

Abstract

Controversy exists regarding the most appropriate treatment for the rare adult patient who develops a so-called pediatric cancer. We have reviewed our 20-year experience with these patients and analyzed their outcome. A total of 299 patients with rhabdomyosarcoma (106), Wilms' tumor (97), and neuroblastoma (96) were evaluated and treated at Stanford University Medical Center between January 1967 and December 1987. Only 26 of these patients (8.7%) were diagnosed during “adulthood”; their age range was 18–67 years, median 23 years. Wilms' tumor: Five patients presented with Wilms' tumor at age ≥ 18 years; four had unfavorable histology. All underwent multimodality therapy; however, only two have survived, one currently disease-free and one with disease. Neuroblastoma: Five patients presented with neuroblastoma at age ≥ 18 years. Four underwent attempted surgical resection, post-operative irradiation (RT), and chemotherapy (CT); the other received no adjuvant CT. Only two of the five patients survive, both with disease. Rhabdomyosarcoma: Of the 16 adults (≥21 years) with rhabdomyosarcoma, 14 (87%) had advanced Intergroup Rhabdomyosarcoma Study-group disease (eight Group III, six Group IV). All 16 underwent aggressive multimodality therapy. At 10 months-16 years follow-up, only five patients survive, four of whom are apparently cured of their tumor. Neither histologic subtype nor site of presentation were of prognostic value. This series demonstrates that adults with Wilms' tumor, neuroblastoma, or rhabdomyosarcoma have a worse prognosis than do children with the same diagnosis. Possible explanations for this disparity in outcome include different tumor biology, less tolerance for treatment, and different natural history among adults relative to children.

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There are limited data regarding the impact of age on treatment patterns and outcomes of WT. Small case series, single institution experiences, and population based studies have reported significantly worse survival for adult WT than pediatric WT.2,5,11-18 In contrast, multi-institutional cooperative WT studies have reported comparable outcomes to that of children when patients are treated with protocol-driven, risk-stratified, multimodal therapy.19,20
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The 3-year overall survival rates were 75% for patients ≤18 years and 9% for patients >18 years of age (P=.003, log-rank test). Several studies have reported an inferior survival outcome in adults compared to children with RMS (45-47). Possible explanation for inferior results with adult RMS include decreased tolerance of patient to chemotherapy and RT, higher rate of unfavorable histology and tumor location in unfavorable sites (45).
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^☆: Presented at the 30th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, New Orleans, LA, October 11, 1988.

View full text

Original contributionTreatment results among adults with childhood tumors: A 20-year experience☆

Abstract

J. Urol.

Int. J. Radiat. Oncol. Biol. Phys.

Neuroblastoma in adults. Pathologic findings and clinical outcome

Arch. Pathol. Lab. Med.

Wilms' tumor in an adult: long time survival with palliative resection of lung and brain metastases

J. Urol.

Wilms' tumor in the adult patient. Diagnosis, management, and review of the world medical literature

Cancer

Histopathology and prognosis of Wilms' tumor. Results from the first National Wilms' Tumor Study

Cancer

Concepts in the natural history and treatment of medulloblastoma in children

CRC Crit. Rev. Radiol. Sci.

Wilms' tumor in adult patients: SIOP results in 15 patients (Abstr.)

Anaplastic Wilms' tumor: clinical and pathologic studies

J. Clin. Oncol.

Prognosis for Wilms' tumor patients with nonmetastatic disease at diagnosis-results of the Second National Wilms' Tumor Study

J. Clin. Oncol.

Wilms' tumor: prognostic factors for patients with metastases at diagnosis

Cancer

Amplification of N-myc in untreated human neuroblastomas correlates with advanced disease

Science

Single copies of the Nmyc oncogene in neuroblastomas from children presenting with the syndrome of opsoclonus-myoclonus

Cancer

Neuroblastoma: influence of age at diagnosis, stage, tumor site, and sex on prognosis

Cancer

Wilms' tumor: its behavior and prognosis

J. La. State Med. Soc.

Observations on growth rates of human tumors

Am. J. Roentgenol.

Regression models and life tables

J. R. Stat. Soc. B.

The treatment of Wilms' tumor: the results of the second National Wilm's Tumor Study

Cancer

Biology and management of Wilms' tumor

Salvage therapy in metastatic adult Wilms' tumor

Cancer

Neuroblastoma in the adult. Effective combination chemotherapy

Cancer

A proposed staging for children with neuroblastoma

Cancer

Flow cytometric DNA analysis of neuroblastoma. Correlation with histology and clinical outcome

Cancer

Original contribution
Treatment results among adults with childhood tumors: A 20-year experience☆