Table 2.
SIOP-2001 Treatment Approach
| Stage | Preoperative Chemotherapy | Histology | Other Clinical or Biologic Factor | Postoperative Chemotherapy | XRT |
|---|---|---|---|---|---|
| I | AV × 4 weeks | Low risk | None | None | |
| Intermediate risk | Postoperative tumor volume > 500 mL* | AV × 4 weeks | None | ||
| High risk | AVD × 27 weeks | None | |||
| II | AV × 4 weeks | Low risk | AV × 27 weeks | None | |
| Intermediate risk | Postoperative tumor volume > 500 mL* | AV × 27 weeks v AVD × 27 weeks | None | ||
| High risk | DCBE × 34 weeks | 25.2 Gy flank XRT; 10.8-Gy boost for lymph node involvement or gross disease | |||
| III | AV × 4 weeks | Low risk | AV × 27 weeks | None | |
| Intermediate risk | Postoperative tumor volume > 500 mL* | AV × 27 weeks v AVD × 27 weeks | 14.4 Gy flank XRT; 10.8-Gy boost for lymph node involvement or gross disease | ||
| High risk | DCBE × 34 weeks | 25.2 Gy flank XRT; 10.8-Gy boost for lymph node involvement or gross disease | |||
| IV | AVD × 6 weeks | Low risk | Lung nodule CR† | AVD × 27 weeks | Flank XRT for local stage III‡ |
| No lung CR | DCBE × 34 weeks | 15 Gy lung; flank XRT for local stage III‡ | |||
| Intermediate risk | Lung nodule CR† | AVD × 27 weeks | Flank XRT for local stage III‡ | ||
| No lung CR | DCBE × 34 weeks | 15 Gy lung; flank XRT for local stage III‡ | |||
| High risk§ | Lung nodule CR† | DCBE × 34 weeks | Flank XRT for local stage II/III‡ | ||
| No lung CR | DCBE × 34 weeks | 15 Gy lung; flank XRT for local stage II/III‡ |
Abbreviations: AV, dactinomycin/vincristine; AVD, dactinomycin/vincristine/doxorubicin (cumulative doxorubicin dose, 250 mg/m2 for stage I to III; 300 mg/m2 for stage IV); CR, complete response; DCBE, doxorubicin/cyclophosphamide/carboplatin/etoposide (cumulative doxorubicin dose, 300 mg/m2 for stage IV); SIOP, International Society of Pediatric Oncology; XRT, radiation therapy.
In Germany, tumor volume > 500 mL after preoperative chemotherapy without stromal or epithelial predominance was assigned to high-risk histology.
CR attained by chemotherapy or metastasectomy.
Metastatic sites other than lung were also irradiated; XRT dose varied according to metastatic site.
Metastatic site irradiation regardless of response was mandated for anaplastic histology primary tumors and not if the abdominal tumor was blastemal type, unless anaplastic features were also found.