Considerations in the radiation therapy of Wilms' tumor

A review of 156 children with a diagnosis of Wilms' tumor seen and treated at the CHMC—CCRF from January 1, 1960 to December 31, 1970 is presented. No demonstrable effect of age at presentation on subsequent prognosis could be identified. A staging system is presented which is readily used and correlates well with prognosis. Ninety-one of 156 children survive without evidence of Wilms' tumor. Sixty-eight of 93 (73%) children who received all therapy at CHMC—CCRF survive. Large primary size and major extra-renal vascular involvement did not affect the prognosis within a given stage. Tumor spill noted at operation requires subsequent whole abdominal irradiation to adequate doses to prevent local abdominal recurrence. A correlation of vascular involvement with pulmonary metastases is made. The incidence, sites, time, and treatment of relapse is presented. Optimum survival for the child with Wilms' tumor requires a thorough interdisciplinary approach of surgical, medical, and radiation oncologists. Careful follow-up is necessary so that when relapse occurs, especially in the lungs, it can be detected at the earliest possible time, assuring the maximum possible salvage in these patients.