Treatment of Wilms' tumor and factors affecting prognosis

• Published in: Cancer Vol. 32; no. 3; pp. 609 - 617
• Main Authors: Perez, Carlos A., Kaiman, Harold A., Keith, John, Mill, William B., Vietti, Teresa J., Powers, William E.
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 01.09.1973
• Subjects: Child; Child, Preschool; Dactinomycin - therapeutic use; Evaluation Studies as Topic; Female; Humans; Infant; Kidney - pathology; Kidney Neoplasms - drug therapy; Kidney Neoplasms - pathology; Kidney Neoplasms - radiotherapy; Kidney Neoplasms - surgery; Kidney Neoplasms - therapy; Lymphatic Metastasis - pathology; Male; Neoplasm Metastasis - pathology; Neoplasms, Multiple Primary; Nephrectomy; Prognosis; Radiotherapy Dosage; Renal Veins - pathology; Retrospective Studies; Vena Cava, Inferior - pathology; Vincristine - therapeutic use; Wilms Tumor - drug therapy; Wilms Tumor - pathology; Wilms Tumor - radiotherapy; Wilms Tumor - surgery; Wilms Tumor - therapy
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(197309)32:3<609::AID-CNCR2820320313>3.0.CO;2-7

Forty‐nine cases of Wilms' tumor treated at the Mallinckrodt Institute of Radiology and Children's Hospital, Washington University Medical Center, between 1950 and December 1969, were retrospectively analyzed. The most important prognostic factors were the anatomical stage of the tumor and some pathologic findings such as invasion of the renal capsule, the renal vein or inferior vena cava, and metastases to the regional lymph nodes or to other organs. A histopathologic classification based on differentiation of the tumor is presented and correlated with cure rates. Stage I lesions had a very good prognosis (85% 3‐year survival NED), even without high‐dose irradiation or prolonged chemotherapy. Triple therapy, involving nephrectomy, irradiation, and prolonged chemotherapy yielded a 55% survival rate in patients with Stage II and 30% in Stage IV (patients with pulmonary metastases). Stage III tumors showed an unsatisfactory response to this comprehensive approach. Patients with bilateral tumors are potentially curable if aggresively treated. From this study it can be concluded that: 1. thorough analysis of the clinical and pathologic characteristics of the tumor should be made in every case and management should be individualized, to avoid excessive treatment in early lesions with favorable prognosis, and 2. carefully administered postoperative irradiation and prolonged chemotherapy may improve the poor results in extensive lesions, even in the presence of distant metastases, with relatively minor sequelae in the surviving children. The late effects of vigorous and prolonged chemotherapy on the bone marrow, the immunologic surveillance system, and the germinal cells of the gonads as well as the repercussion on normal growth of these children remain to be evaluated.