What is the role of chemotherapy in the treatment of Wilms tumor?

Updated: Feb 01, 2019
  • Author: Tunc Ozan, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Answer

Multimodal therapy (ie, surgery, radiation, chemotherapy) is the key to success when treating Wilms tumor. [6, 20] The NWTSG recommends preoperative chemotherapy (after initial exploratory laparotomy and biopsy) in the following situations [7, 8, 10] :

  • Intracaval tumor extension - This occurs in 5% of cases of Wilms tumor and is associated with a 40% rate of surgical complications, even in experienced hands; up-front chemotherapy after staging and biopsy reduces tumor and thrombus size, which account for 25% of surgical complications

  • Inoperable tumors - Large tumors that involve vital structures make resection difficult; the complication rate is high, and the incidence of tumor spill soilage is also high, although up-front chemotherapy reduces soilage by 50%

  • Bilateral Wilms tumor

SIOP advocates up-front chemotherapy without previous laparotomy and biopsy. The NWTSG suggests that this approach results in a 1-5% risk of treating a benign disease. [11]

Chemotherapy without proper surgical staging (eg, staging by means of imaging studies only) may alter the actual initial stage of the disease by the time of surgery and may subsequently alter decisions regarding the adjuvant chemotherapy and radiation therapy, which is based on the surgical staging.


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