Article

Current challenges in Wilms' tumor management.

Great Ormond Street Hospital, London, UK.
Nature Clinical Practice Oncology (impact factor: 8). 07/2005; 2(6):298-304; quiz 1 p following 324. DOI:10.1038/ncponc0196 pp.298-304; quiz 1 p following 324
Source: PubMed

ABSTRACT Wilms' tumor is a renal cancer that predominantly affects children during the first 2 years of life. The continuing success of clinical trials in Wilms' tumor patients over the past 30 years has led to an overall survival of 85%, and treatment-related morbidity has been reduced. Less-aggressive chemotherapeutic regimes are available for patients with validated good prognostic factors, such as low stage and favorable histology. It is becoming increasingly apparent that treatment can be optimized through stratification of patients according to tumor stage and histology. Established treatments for Wilms' tumor include perioperative vincristine and actinomycin, with or without doxorubicin or radiotherapy. Relapsed patients have the option of salvage chemotherapy with ifosfamide, carboplatin and etoposide, as well as high-dose chemotherapy regimes and autologous hemopoietic stem-cell rescue. Further research is required to refine these regimes and identify further the role of additional prognostic factors in this childhood disease. In this article we discuss the most-debated issues and advances that have been made in the management of Wilms' tumor.

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Keywords

additional prognostic factors
 
autologous hemopoietic stem-cell rescue
 
childhood disease
 
continuing success
 
doxorubicin
 
first 2 years
 
high-dose chemotherapy regimes
 
Less-aggressive chemotherapeutic regimes
 
low stage
 
most-debated issues
 
perioperative vincristine
 
renal cancer
 
tumor stage
 
validated good prognostic factors
 
Wilms' tumor
 
Wilms' tumor patients
 

Lyndon M Gommersall