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How is Wilms' tumor treated?
Last reviewed: 23.04.2024
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Treatment of Wilms tumor depends on the stage and histological structure. Nephroblastoma is one of the first tumors in the treatment of which a complex approach was applied.
Treatment of Wilms tumor (protocol of the National Research Group on the Study of Wilms' Tumor)
|
Stage |
Healing measures |
|
Stage I (favorable histological structure) |
Operation, radiotherapy is not performed, chemotherapy - dactinomycin + vincristine |
|
Stage I anaplasia (unfavorable histological structure) |
Operation, radiotherapy is not performed, chemotherapy (dactinomycin + vincristine) for 6 months |
|
Stage II (favorable histological structure) |
Operation, radiotherapy is not performed, chemotherapy in mode 1 (dactinomycin + vincristine) |
|
Stage III (favorable histological structure) |
Operation, radiotherapy on a bed of a tumor in the total focal dose of 10.8 Gy, chemotherapy - dactinomycin + vincristine + Doxorubicin |
|
Stage IV (favorable histological structure) |
Operation, radiotherapy on the tumor bed in the total focal dose of 10.8 Gy, chemotherapy - dactinomycin + vincristine + doxorubicin |
|
Stage II-IV (unfavorable histological structure) |
Cyclophosphamide is added to dactinomycin, vincristine and doxorubicin |
Children younger than 12 months are recommended to reduce the dose of all drugs by 50%. Chemotherapy treatment with full doses of drugs is administered to children over 12 months of age.
Surgical treatment is concluded in the removal of the tumor, the establishment of its histological appearance and the stage of the disease. Radiation therapy with nephroblastoma is used in some cases in the III and IV stages of the disease. The chemotherapy regimen for nephroblastoma depends on the stage of the disease and includes the use of dactinomycin, vincristine and doxorubicin. Preoperative chemotherapy in the US is rarely used, but in Europe it is mandatory. One of the problems of preoperative chemotherapy is the error of the preoperative diagnosis of Wilms tumor in 6% of cases. The SIOP research team argues for the need for preoperative chemotherapy in that most of the misdiagnoses are neuroblastoma. SIOP studies have shown that preoperative chemotherapy reduces the incidence of tumor rupture during surgery from 32 to 4%, and also reduces the stage of the disease - in 80% of patients after 4-week preoperative chemotherapy with vincristine and dactinomycin at the time of surgery, nephroblastoma was detected in stage I-II . In the United States, preoperative chemotherapy is used only in patients with disseminated lesions or with an inoperable tumor, as well as with bilateral nephroblastoma.
Forecast
The prognosis in patients with nephroblastoma depends on a number of factors. Unfavorable prognostic factors:
- III-V stage;
- metastases in para-aortic lymph nodes;
- anaplastic or sarcomatous histological structure;
- rupture of the tumor before or during surgery;
- metastases in the liver (metastasis to the lungs is more favorable than metastasis to the liver).
Results of Wilms tumor treatment
|
Stage (favorable histological structure) |
Relapse-free two-year survival rate,% |
Total four-year survival rate,% |
|
I |
89 |
95.6 |
|
II |
87.4 |
91.1 |
|
III |
82 |
90.9 |
|
IV |
79 |
80.9 |
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