Treatment and prognosis in Wilms' tumor.A study of 51 cases with special reference to the role of actinomycin D

A total of 51 patients with Wilms' tumor have been treated at Walter Reed General Hospital in 16 years. The 2-year survival rate was 44% and the 3-year survival rate 42%. Most patients had nephrectomy followed by postoperative irradiation. Patients treated after 1960 received actinomycin D either in the immediate postoperative period in conjunction with irradiation or subsequently when metastases developed. The addition of actinomycin D has not influenced the cure rate. However, the methods of treatment selection and the total number of cases prohibits proper staistical analysis. In addition, the immediate use of actinomycin D in the postoperative period along with irradiation has not prolonged survival. When actinomycin D has been reserved for subsequent use for later metastases or recurrent tumor there appears to be a definite increase in survival time. Both radiation therapy alone and combined with actinomycin D has been quite effective in controlling lung metastases. The complications of irradiation and actinomycin D in the treatment of Wilms' tumor have been briefly reviewed and found to be minimal in the present series.