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Management of Wilms Tumor: ICMR Consensus Document
Maya Prasad1, Tushar Vora2, Sandeep Agarwala3
1Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India.
Indian Journal of Pediatrics
|April 4, 2017
Summary
Wilms tumor (WT), a common childhood kidney cancer, shows improved survival with multidisciplinary care. Further improvements are needed in resource-poor settings, emphasizing preoperative chemotherapy and delayed surgery for large tumors.
Area of Science:
- Pediatric Oncology
- Nephrology
- Surgical Oncology
Background:
- Wilms tumor (WT) is the most prevalent renal malignancy in children.
- Current multidisciplinary care has improved survival rates, but challenges remain in resource-limited settings.
- Large tumor size at presentation is common in resource-poor areas, necessitating tailored treatment strategies.
Purpose of the Study:
- To outline a comprehensive management strategy for Wilms tumor (WT), particularly in resource-limited settings.
- To detail the role of preoperative chemotherapy, delayed surgery, and risk stratification in WT treatment.
- To provide guidelines for imaging, surgical procedures, chemotherapy regimens, and radiotherapy indications in WT management.
Main Methods:
- Contrast Enhanced CT scan (CECT) of the thorax, abdomen, and pelvis for initial staging and re-evaluation.
- Risk stratification based on histology and staging.
- Surgical intervention: Radical Nephroureterectomy and Lymph node sampling at week 5 (non-metastatic) or week 7 (metastatic).
- Preoperative chemotherapy regimens: Vincristine/Actinomycin for 4 weeks (non-metastatic) or 6 weeks with Adriamycin (metastatic).
- Postoperative chemotherapy tailored to stage and histology.
- Radiotherapy indications, primarily for Stage III and IV WT.
Main Results:
- Wilms tumor is highly sensitive to chemotherapy and radiotherapy.
- Preoperative chemotherapy followed by delayed surgery is a preferred approach for large or unresectable tumors.
- Specific chemotherapy protocols and surgical timing are recommended based on metastatic status.
- Radiotherapy is a key component for advanced stages (III and IV).
Conclusions:
- A structured, multidisciplinary approach is crucial for optimizing Wilms tumor outcomes, especially in resource-limited environments.
- Adherence to recommended chemotherapy, surgical timing, and radiotherapy protocols can further enhance survival rates.
- The described strategy addresses the unique challenges of managing Wilms tumor in settings with limited resources.
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