Prognosis and treatment of Wilms' tumor at Great Ormond Street Hospital for Sick Children--1960-1972
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Wilms' tumor survival rates varied significantly by stage, with advanced stages showing poorer outcomes. Intensive therapy, including multi-drug chemotherapy, is crucial for improving survival in advanced Wilms' tumor cases.
Area of Science:
- Pediatric Oncology
- Nephrology
Background:
- Wilms' tumor is a common pediatric kidney cancer.
- Treatment strategies and survival rates have evolved over time.
Purpose of the Study:
- To review treatment outcomes and survival rates for Wilms' tumor in children treated between 1960-1972.
- To identify prognostic factors and necessary therapeutic interventions for improved patient outcomes.
Main Methods:
- Retrospective review of 81 children diagnosed with Wilms' tumor.
- Utilized the National Wilms' Tumor Study group staging system for classification.
- Analysis of age, sex, treatment, and survival data.
Main Results:
- Survival rates were 87% (Stage I), 36% (Stage II), 8% (Stage III), and 33% (Stage IV).
- Locally advanced tumors had worse survival than those with pulmonary metastases and resectable primary tumors.
- Whole abdominal irradiation is critical for tumors breaching the renal capsule.
- Single-agent chemotherapy was ineffective for advanced tumors; multi-drug chemotherapy improved disease-free survival.
Conclusions:
- Wilms' tumor prognosis is heavily stage-dependent.
- Advanced Wilms' tumor requires intensive therapeutic approaches, including multi-drug chemotherapy, nephrectomy, and whole abdominal irradiation.
- Current intensive therapies show promise in enhancing disease-free survival for pediatric Wilms' tumor patients.
Abstract:
Eighty-one children with a diagnosis of Wilms' tumor who were treated at the Great Ormond Street Hospital for Sick Children between 1960 and 1972 are reviewed. The National Wilms' Tumor Study group staging system is used. Distribution by age and sex in each stage together with survival rate is given. Treatment and prognostic factors are discussed. Wilms' tumor is most common in children below the age of 3 years. There was a survival rate of 87% in Stage I, 36% in Stage II, 8% in Stage III, and 33% in Stage IV. The survival was worse in patients with locally advanced tumor than in patients who had pulmonary metastases in association with a locally resectable tumor. Whole abdominal irradiation is necessary in all patients in whom the tumor has breached the renal capsule. Single agent chemotherapy has not proved effective in preventing relapse in patients with advanced tumors. More intensive therapy is needed in this group to prevent both local recurrence and distant metastases. The addition of multiple drug chemotherapy to nephrectomy and whole abdominal irradiation is already improving the disease-free survival.