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Management of Wilms tumor: current standard of care

Geoffrey Sonn1, Linda M D Shortliffe

  • 1Stanford University Medical Center, Stanford, CA 94305-5118, USA.

Nature Clinical Practice. Urology
|October 7, 2008
PubMed

Insights

Childhood Wilms tumor survival has dramatically improved to 90% due to multidisciplinary therapy. Current research focuses on reducing treatment-related morbidity, such as organ damage and secondary cancers.

Area of Science:

  • Pediatric Oncology
  • Pediatric Surgery
  • Medical Malignancies

Background:

  • Wilms tumor is the most common kidney cancer in children.
  • Historically, survival rates were low (approx. 30% in the 1930s).
  • Multidisciplinary therapy has significantly improved survival to about 90%.

Purpose of the Study:

  • To compare the differing management strategies for Wilms tumor in Europe and the US.
  • To highlight the current focus on reducing treatment-related morbidity.
  • To assess the current role of laparoscopic surgery in Wilms tumor management.

Main Methods:

  • Comparison of European (neoadjuvant chemotherapy followed by surgery) and US (primary surgery followed by chemotherapy) protocols.
  • Review of outcomes and survival rates associated with different management strategies.
  • Identification of significant treatment complications and current surgical limitations.

Main Results:

  • Both European and US protocols achieve similar, excellent overall survival rates for Wilms tumor.
  • Treatment complications include cardiomyopathy, renal failure, and secondary malignancies.
  • The use of laparoscopic surgery in Wilms tumor management is currently very limited.

Conclusions:

  • Wilms tumor management strategies in Europe and the US yield comparable high survival rates.
  • The primary goal in Wilms tumor treatment has shifted towards minimizing long-term therapy-related side effects.
  • Minimally invasive surgical approaches like laparoscopy have a restricted role in current Wilms tumor care.

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