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Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQ®)

  • Updated: 08/15/2014

Table 6. Overview of Standard Treatment for Stage IV Wilms Tumor

Stage Histology 4-Year RFS or EFS 4-Year OS Treatment (refer to Table 2 for chemotherapy regimen descriptions) 
Stage IV [67,100]FH76% RFS86%Nephrectomy + lymph node sampling, followed by abdominal XRT,a radiation to sites of metastases, bilateral pulmonary XRT,b and regimen DD-4A
FA61% EFS72% (n = 11)Nephrectomy + lymph node sampling, followed by abdominal XRT,a radiation to sites of metastases, bilateral pulmonary XRT,b and regimen DD-4A
DA33% EFS33% (n = 15)Immediate nephrectomy + lymph node sampling followed by abdominal XRT,a radiation to sites of metastases, whole-lung XRT,b and regimen I
DA (preoperative treatment)31% EFS44% (n = 13)Preoperative treatment with regimen I followed by nephrectomy + lymph node sampling, followed by abdominal XRT,a radiation to sites of metastases, and whole-lung XRTb

DA = diffuse anaplasia; EFS = event-free survival; FA = focal anaplasia; FH = favorable histology; OS = overall survival; RFS = relapse-free survival; XRT = radiation therapy.
aAbdominal XRT is planned according to local stage of renal tumor.
bPulmonary XRT is reserved for patients with chest X-ray/chest CT evidence of pulmonary metastases.

References

  1. Grundy PE, Breslow NE, Li S, et al.: Loss of heterozygosity for chromosomes 1p and 16q is an adverse prognostic factor in favorable-histology Wilms tumor: a report from the National Wilms Tumor Study Group. J Clin Oncol 23 (29): 7312-21, 2005.  [PUBMED Abstract]

  2. Dome JS, Cotton CA, Perlman EJ, et al.: Treatment of anaplastic histology Wilms' tumor: results from the fifth National Wilms' Tumor Study. J Clin Oncol 24 (15): 2352-8, 2006.  [PUBMED Abstract]