From the Guidelines
Wilms' tumor is typically treated with a combination of surgery, chemotherapy, and sometimes radiation therapy, with the most recent guidelines emphasizing individualized treatment based on tumor stage, histology, and patient characteristics. The treatment approach usually begins with surgical removal of the tumor and affected kidney (nephrectomy), allowing for accurate staging of the disease 1. Following surgery, chemotherapy is administered using medications such as vincristine, dactinomycin, and doxorubicin, with the specific regimen depending on the tumor stage and histology.
Some key points to consider in the treatment of Wilms' tumor include:
- The importance of individualized treatment plans, taking into account the child's age, overall health, and tumor characteristics 1
- The use of chemotherapy and radiation therapy in addition to surgery, with the specific regimen and duration depending on the tumor stage and histology
- The need for regular surveillance and monitoring, particularly in patients with predisposition syndromes or a family history of Wilms' tumor 1
- The potential for emerging new genes and predisposition syndromes to be associated with an increased risk of Wilms' tumor development, highlighting the need for ongoing research and updates to surveillance guidelines 1
In terms of surveillance, renal ultrasounds every 3 months are recommended for patients with predisposition syndromes, from birth or diagnosis through the 7th birthday, and until 8 years of age in certain cases 1. This approach allows for early detection and treatment of Wilms' tumor, which is critical for improving survival rates and outcomes. Overall, the treatment of Wilms' tumor requires a multimodal approach, with a focus on individualized care and regular surveillance to optimize patient outcomes.
From the FDA Drug Label
INDICATIONS AND USAGE: Doxorubicin Hydrochloride Injection, USP has been used successfully to produce regression in disseminated neoplastic conditions such as ... Wilms' tumor, ... Doxorubicin is used to treat Wilms' tumor.
- The drug is administered intravenously (IV). The treatment of Wilms' tumor with doxorubicin is supported by the FDA drug label 2.
From the Research
Treatment Options for Wilms' Tumor
- Surgical excision, when feasible, is a common treatment approach for Wilms' tumor, often combined with radiation therapy and chemotherapy 3, 4.
- Chemotherapy regimens, such as vincristine (VCR) and actinomycin D (AMD), with or without doxorubicin (DOX), have been used to treat Wilms' tumor, with varying degrees of success 5, 6.
- Alternating courses of cyclophosphamide/etoposide and carboplatin/etoposide have been used to treat relapsed Wilms' tumor, resulting in approximately 42.3% four-year event-free survival and 48.0% overall survival 7.
Chemotherapy Regimens
- VCR and AMD, with or without DOX, have been used as initial chemotherapy for Wilms' tumor, with four-year relapse-free survival rates ranging from 53.3% to 80.9% 5, 6.
- The addition of DOX to VCR and AMD has been shown to improve outcomes in some cases, but not consistently 6.
- Cyclophosphamide and etoposide have been used in combination with other agents, such as carboplatin, to treat relapsed Wilms' tumor 7.
Surgical Approaches
- Open nephrectomy is still the most recommended surgical approach for Wilms' tumor, offering excellent survival rates 4.
- Nephron-sparing surgery may be an important step in preserving quality of life for patients with Wilms' tumor, but selection of patients is necessary to avoid failures and decreasing survival rates 4.
- Minimally invasive nephrectomy is not recommended for Wilms' tumor, but may be considered in rare cases with careful selection and experienced surgeons 4.