Management of children with wilms' tumor

Improvement in the survival rate of patients with Wilms' tumor has been notable. Advances in surgery, radiation therapy, and chemotherapy have changed the outlook for what was once considered a hopeless condition. Coordinated regimens encompassing all three forms of treatment have resulted in 80% survival for two years or more. Chemotherapeutic agents have made a notable contribution to success. The first antineoplastic substance that was shown to have a consistently marked effect against Wilms' tumor was actinomycin D. Vincristine soon was found to be extremely active also. The National Wilms' Tumor Study was organized to refine methods of therapy. One of its aims is to define the role of radiation therapy in patients with well-localized tumors. Another objective is to determine which of the two agents known to be effective is more efficient, and whether their combination is superior to treatment with either one alone. Other chemical agents also have been tested; adriamycin is the most promising of these.