eMedicine Specialties > Urology > Cancer, Wilms Tumor and Neuroblastoma

Wilms Tumor: Follow-up

Author: Marc Cendron, MD, Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston
Contributor Information and Disclosures

Updated: May 5, 2009

Outcome and Prognosis

With the advent of multimodal therapy, the prognosis of Wilms tumor (WT) is good, and it is considered an example of success in cancer therapy. The overall survival rate of Wilms tumor is 90%. Cases that involve diffuse anaplasia and stage III or IV disease that recur despite complex therapy have a much poorer prognosis. However, the addition of newer chemotherapeutic agents such as cyclophosphamide, ifosfamide, cisplatin, carboplatin, and etoposide, especially the ICE combination (ifosfamide, carboplatin, etoposide), have contributed to significantly increased postrelapse survival rates to 50%-60%.

Future and Controversies

The purpose of NWTSG-5, which is now closed for patient accrual, was to increase the cure rate in patients with unfavorable histology by using chemotherapy regimens based also on cyclophosphamide and etoposide (VP-16). Another goal of NWTSG is to reduce the rate of adverse effects of treatment by modifying the radiotherapy delivery technique to the abdomen and lung.

In addition, using risk stratification based on tumor molecular profile may allow treatment to be tailored for each patient individually.

Clinical outcomes may be further improved through promising new cytotoxic agents such as the camptothecin analogue topotecan. Another promising class of chemotherapeutic agents are the antiangiogenesis agents, which target the vascular endothelial growth factor (VEGF) pathway.

 


More on Wilms Tumor

Overview: Wilms Tumor
Workup: Wilms Tumor
Treatment: Wilms Tumor
Follow-up: Wilms Tumor
References
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References

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Further Reading

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Keywords

Wilms tumor, nephroblastoma, WT, embryoma of the kidney, mixed tumor of the kidney, sporadic Wilms tumor, familial Wilms tumor, bilateral Wilms tumor, Beckwith-Wiedemann syndrome, hemihypertrophy, congenital aniridia, WAGR syndrome, Denys-Drash syndrome, trisomy 18 mutation, teratoid Wilms tumor

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Contributor Information and Disclosures

Author

Marc Cendron, MD, Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston
Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

Medical Editor

Leonard Gabriel Gomella, MD, FACS, The Bernard W Godwin Professor of Prostate Cancer Chairman, Department of Urology, Associate Director of Clinical Affairs, Kimmel Cancer Center, Thomas Jefferson University
Leonard Gabriel Gomella, MD, FACS is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Urological Association, Sigma Xi, Society for Basic Urologic Research, Society of University Urologists, and Society of Urologic Oncology
Disclosure: GSK Consulting fee Consulting; Astra Zeneca Honoraria Speaking and teaching; Watson Pharmaceuticals Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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