Dactinomycin in Wilms' Tumor

Of 122 children with Wilms' tumor treated at eight institutions, 45 received conventional therapy (surgery and irradiation) alone, 59 received conventional therapy and "early" administration of dactinomycin (actinomycin D), and 18 received conventional therapy and "late" administration of dactinomycin. In 102 children without metastasis at operation, life-table analysis revealed a decreased frequency of metastasis and increased survival after dactinomycin therapy. Children starting drug therapy the day of operation had a clearly improved survival experience at four years after operation over those not receiving drug therapy. Patients with metastasis had an improved survival experience even if dactinomycin therapy was started late, as compared with patients who received no drug therapy. Dactinomycin therapy improved survival experience even when metastasis was evident at operation. Survival experience did not differ between sexes and was better for younger than for older children.