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Adherence to Protocol Recommendations for Children With Wilms Tumour in Two Consecutive Studies in the United Kingdom
Suzanne Tugnait1, R Al-Saadi2, A Lopez-Cortes1
1Developmental Biology & Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
Background And Aims:
Wilms tumour (WT) has excellent event-free and overall survival (OS). However, small differences exist between countries participating in the same international study. This led us to examine variation in adherence to protocol recommendations as a potential contributing factor.
Methods:
Retrospective analysis of risk-stratified chemotherapy and radiotherapy regimens given to children with unilateral WT treated with pre-operative chemotherapy in the SIOPWT2001 (2002-2011) and Improving Population Outcomes for Renal Tumours of Childhood (IMPORT) (2012-2018) studies in the United Kingdom and Ireland. Pre- and post-operative treatments were classified as per protocol (PP), deviation (PDEV)-variation for specified clinical reasons, violation (PVIOL)-not treated PP.
Results:
A total of 1256 children with WT were registered by 20 centres. A total of 1052 (84%) had unilateral WT treated with pre-operative chemotherapy. All had centrally reviewed pathology. Case report forms allowing categorisation of the whole treatment pathway were available for 756 (72%) patients. Treatment was classified as PP in 452 (60%), PDEV in 175 (23%) and PVIOL in 129 (17%). Stage III/IV tumours had higher proportion PVIOL (21% and 35%, respectively) compared to Stage I/II tumours (8%-10%). Two-thirds of patients were treated in 'high-volume' centres (≥5 new WTs/year). Protocol adherence rates were similar between high- and low-volume centres. Protocol adherence category had no impact on event-free or OS.
Conclusions:
Protocol guidelines are followed closely for lower stage tumours, but there is greater variation in advanced disease. Centre size showed no association with survival, emphasising the effectiveness of using a national treatment protocol, supported by central pathology review.
