Wilms' tumor—An interdisciplinary treatment program with and without dactinomycin

Abstract

From 1945 through 1970, 61 patients with Wilms' tumor were analyzed for the treatment of primary tumor or metastatic lesions and for the development of metastases. Between 1945 and 1962, 21 patients were treated by nephrectomy and radiation therapy to the tumor beds; 10 of these (48%) remain well. Since 1962, dactinomycin has been added to the treatment program of 40 patients. Twenty-two of these patients were treated entirely at UCSF; 18 (82%) have no evidence of disease after 2 years or more. Eighteen cases were referred after initial treatment elsewhere; seven (39%) remain free of disease for the 2-year at risk period. Maintenance courses of dactinomycin resulted in a marked decrease in the subsequent incidence of pulmonary metastases. It is concluded that an improved cure rate of Wilms' tumor can be achieved with a combination of dactinomycin, radiation therapy, and surgery under the guidance of an experienced oncology team.