Long-term complications and post-treatment follow-up of patients with Wilms' tumor

An increasing number of children with Wilms' tumor can expect to be cured, reflecting the undisputed progress made in the treatment of children with this renal cancer. However, it does underscore the need to screen survivors for late effects of cancer therapy. Some of the late effects, such as those following radiation therapy, should be expected after a considerable latent period. Others, such as those occurring after the administration of certain chemotherapeutics agents, are commonly immediate, usually transient, but occasionally permanent. Although children seem to tolerate acute toxicities of therapy better than do adults, the growing child may be more vulnerable to the delayed adverse sequelae of cancer therapy, such as effects on growth, fertility, and neuropsychological function. This article reviews many of the late effects seen in survivors of Wilms' tumor and the way in which these effects relate to the different therapeutical modalities used (surgery, chemotherapy, and radiation).