Recent experience with Wilms' tumor: 1978-1991

Area of Science:

• Pediatric Oncology
• Nephrology
• Cancer Research

Background:

• Wilms tumor treatment has evolved significantly over the past four decades.
• Current therapeutic strategies are informed by tumor stage and histological subtype.
• This study assesses treatment outcomes from protocols designed to minimize doxorubicin use.

Purpose of the Study:

• To evaluate the efficacy of Wilms tumor treatment protocols.
• To assess outcomes in patients treated with regimens generally avoiding doxorubicin.
• To identify potential treatment de-escalation strategies for specific Wilms tumor subtypes.

Main Methods:

• Retrospective review of 114 children with renal tumors treated between 1978 and 1991.
• Classification of tumors into favorable histology Wilms tumor (91 patients) and unfavorable histology (23 patients).
• Chemotherapy regimens evolved over two eras (1978-1982 and 1983-1991), with doxorubicin reserved for specific cases or regimens.
• Radiotherapy was administered to the tumor bed in approximately two-thirds of patients.

Main Results:

• No isolated local failures were observed in favorable histology patients receiving radiotherapy.
• Event-free survival did not differ significantly among favorable histology patients across different stages.
• Patients with rhabdoid/sarcomatous Wilms tumor variants showed significantly poorer survival (p=0.00).
• Stage I tumors treated with nephrectomy alone demonstrated excellent outcomes (100% survival).

Conclusions:

• Wilms tumors remain highly curable, with survival rates exceeding expectations.
• Certain unfavorable histology Wilms tumors necessitate intensive therapeutic approaches.
• Observation without adjuvant therapy may be optimal for select stage I Wilms tumors to prevent treatment-related toxicity.