Seventy
-four patients with histologically confirmed diagnoses of Wilms' tumor were treated between 1949 and 1978 at the Mallinckrodt Institute of Radiology and St. Louis Children's Hospital. The results have been divided into two eras of therapy, Le., before and after 1965, when chemotherapy became a major modality for Wilms' tumor therapy. Analysis at 5 years by era of therapy has shown similar disease-free survival results for Stage I ("prechemotherapy" era 67% versus "chemotherapy" era 75%). whereas the Stage I1 ("prechemotherapy" era 33% versus "chemotherapy" era 100%) and Stage 111 ("prechemotherapy" era 0% versus "chemotherapy" era 70%) are significantly different (P < 0.001). This suggests that chemotherapy has substituted for postoperative irradiation in Stage I patients; whereas in Stage I1 and 111, improved survival occurs as a result of the eradication of subclinical metastatic disease. The patterns of failure by era of treatment are presented and the literature is discussed. Cancer 56:1484-1489, 1985.
ILMS' TUMOR is the most common malignancy W of the genitourinary tract in children and accounts for about 20% of all childhood solid tumors.' Progressive improvement in the relapse-free survival and overall survival has occurred principally as a result of the evolution of effective adjuvant therapy.
Nephrectomy alone has been reported to cure a p proximately 20% to 40% of patients.24 The addition of postoperative flank or whole abdomen irradiation increased disease-free survival rates to 50?h5 Single-agent chemotherapy (dactin~mycin,~.' and later vincristine') after nephrectomy and locoregional irradiation improve survival rates to 60%. Combination chemotherapy (dactinomycin, vincristine, doxorubicin) improve 2-year disease-free survival rates to greater than 75T0.