Unilateral Wilms鈥?tumour (WT) patients, who had chest CT scans at diagnosis showing any sized pulmonary nodules undetected on chest X-ray, between November 2001 and November 2009, were selected from the SIOP 2001 database.
Among 2532 WT patients, 103 unilateral nephroblastoma patients with CT-only lung lesions were found. Thirty-seven patients received preoperative treatment according to the localised-disease protocol, and 66 according to the metastatic-disease protocol. The 3-year event-free survival (EFS) was 70%(95%CI: 55-89%) and 77%(95%CI: 66-89%), respectively. Corresponding 3-year overall survival (OS) was 89%(95%CI: 77-100%) and 85%(95%CI: 75-96%), respectively (p-value not significant). EFS and OS of all 2071 patients with true localised disease were 87%(95%CI: 86-89%) and 96%(95%CI: 94-97%), respectively. Patients with metastatic disease (n = 358) had 3-year EFS and OS estimates of 68%(95%CI: 63-74%) and 77%(95%CI: 72-82%), respectively.
EFS and OS of patients with CT-only lung lesions were inferior to that of true localised-disease patients and superior to that of patients with metastatic disease. However, no significant difference was found in EFS and OS between CT-only patients treated for localised or metastatic disease. The clinician鈥檚 preference to treat patients with CT-only pulmonary nodules as metastatic disease is not evidence-based. Chest CT at diagnosis does not improve outcome but presents paediatric oncologists with a difficult dilemma.