What are the NWTSG guidelines on postoperative chemotherapy and radiotherapy for Wilms tumor?

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

Answer

The NWTSG has published guidelines for postoperative chemotherapy and radiotherapy protocols, based on the surgical staging, as follows:

  • Stage I, with favorable or unfavorable histology: Vincristine and actinomycin D for 18 wk

  • Stage II with favorable histology: Vincristine and actinomycin D for 18 wk

  • Stage II with focal anaplasia: Abdominal radiation (1000 cGy); vincristine, actinomycin D, and doxorubicin for 24 wk

  • Stage III with favorable histology and focal anaplasia: Abdominal radiation (1000 cGy); vincristine, actinomycin D, and doxorubicin for 24 wk

  • Stage IV with favorable histology or focal anaplasia: Abdominal irradiation according to local stage; bilateral pulmonary irradiation (1200 cGy); trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis jiroveci; c hemotherapy with vincristine, actinomycin D, and doxorubicin

  • Stage IV with diffuse anaplasia: Abdominal irradiation; whole-lung irradiation; chemotherapy for 24 months with vincristine, actinomycin D, doxorubicin, etoposide, and cyclophosphamide

A study by Pritchard-Jones et al on 583 children from 251 hospitals in 26 countries aimed to assess whether doxorubicin can be omitted safely from chemotherapy for stage II-III, histological intermediate-risk Wilms' tumor in order to avoid doxorubicin-related cardiotoxicity effects. The study concluded that doxorubicin does not need to be included in treatment of stage II-III intermediate risk Wilms' tumour when the histological response to preoperative chemotherapy is incorporated into the risk stratification. [21]


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