Future directions in clinical research in Wilms tumor

The national and international cooperative study groups have provided the scientific and administrative framework for the evaluation of various treatment regimens in patients with Wilms tumor. These have yielded excellent overall survival rates while identifying prognostic factors that have permitted modulation of therapy according to well-documented risk indices. Thus, they have demonstrated that treatments associated with important acute or long-term morbidities or both are not necessary for such patients as those with NWTS stage I or II, favorable histology Wilms tumor. It is now time to move beyond the traditional randomized prospective clinical trial method, which is not suitable to the attainment of remaining goals. Attempts to decrease the intensity of treatment even more in the future will be based on stratification of patients according to the presence or absence of one or more sensitive biologic prognostic factors. Such "markers," it is to be hoped, will make it possible to eliminate cardiotoxic and nephrotoxic drugs from the treatment of all but those at high risk of relapse.