[Complete remission of a highly malignant, progressive under therapy Wilm's tumor using the combination carboplatin...

A Wilms' tumor in a 4 year old girl did not diminish under preoperative chemotherapy following SIOP 9/GPO study guidelines. Surgery revealed an anaplastic (high grade) nephroblastoma infiltrating pancreas, transverse colon, and diaphragm. During postoperative treatment with ifosfamide, vincristine, actinomycin D, and doxorubicin, there was massive tumor growth per continuitatem in chest and abdomen within 6 weeks. Following a French study for relapsed Wilms' tumor, we gave 160 mg/m2 carboplatin and 100 mg/m2 etoposide on 5 consecutive days. After only one cycle, the tumor showed already remarkable regress. We applied six cycles of carboplatin/etoposide and a abdominal radiation. At the end of therapy, the patient was in complete remission. Side effects of chemotherapy were severe bone marrow aplasia and a moderate and reversible decrease of creatinine clearance. The combination of carboplatin and etoposide is a promising therapy in Wilms' tumor resistant to classic nephroblastoma drugs like vincristine, doxorubicin, and actinomycin D.