title: Results of novel strategies for treatment of Wilms' tumor.
abstract: OBJECTIVE
  To evaluate treatment outcomes in Wilms' tumor (WT).
  
  
  METHODS
  We studied 53 children with median age of 2 years with WT, stages I-19, II-14, III-12, IV-6 and V-2. Treatment consisted of surgical excision plus adjuvant (40 children) or neoadjuvant and adjuvant chemotherapy (unresectable tumor, n=8, or caval tumor extension, n=5). Chemotherapy and radiotherapy followed protocols of Brazilian Wilms' Tumor Study Group excepting 16 cases with stage I disease that received a short duration postoperative treatment with vincristine (VCR - 11 doses) and dactinomycin (AMD - 4 doses). Relapsed WT was treated with multiagent regimens including cisplatin/carboplatin, cyclophosphamide, ifosfamide and etoposide. One patient with resistant relapsed WT was treated by high-dose conditioning chemotherapy with stem cell rescue.
  
  
  RESULTS
  Overall and disease-free survival rates at 5 years were respectively 88.2 +/- 5.0% and 76.7 +/- 6.6%. Short duration therapy for stage I tumor showed a disease-free survival rate of 100% in a median time of 101 months (range 14 to 248 months). Overall and disease-free survival of 10 patients with recurrent WT at 5 years was 42.8%. The child treated with high-dose chemotherapy plus stem cell transplant is alive without evidence of disease 84 months from relapse.
  
  
  CONCLUSIONS
  The postoperative chemotherapy in stage I disease can be reduced without compromising the cure rate. The treatment of unfavorable stage III and IV disease or relapsed tumor remains a challenge.
authors.affiliation: Division of Urology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil. stucci@convex.com.br
authors.forename: Silvio
authors.initials: S
authors.lastname: Tucci
authors.forename: Adauto J
authors.initials: AJ
authors.lastname: Cologna
authors.forename: Haylton J
authors.initials: HJ
authors.lastname: Suaid
authors.forename: Elvis T
authors.initials: ET
authors.lastname: Valera
authors.forename: Luis F
authors.initials: LF
authors.lastname: Tirapelli
authors.forename: Edson L
authors.initials: EL
authors.lastname: Paschoalin
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Martins
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D009392:Nephrectomy; D012008:Recurrence; D009396:Wilms Tumor / Q000188:drug therapy / Q000601:surgery*