title: Treatment of relapsed Wilms tumors: lessons learned.
abstract: Treatment regimens for recurrent Wilms tumor (WT) are currently designed to include drugs that are not used during primary chemotherapy, using a risk-stratified approach. Therapy of recurrent disease depends on the nature of initial treatment, and of recognized prognostic indicators inherent in the primary tumor. Several highly effective chemotherapy regimens, including ifosfamide-carboplatin-etoposide, cyclophosphamide-etoposide and carboplatin-etoposide, are considered first treatment choice for recurrent disease. While intense-dose chemotherapy is uniformly accepted to treat high-risk recurrent WTs, the optimal therapy for standard-risk children has yet to be defined, owing to the small number of such patients and their relatively better prognosis compared with high-risk recurrences. Recurrent tumors among those defined as very-high risk are likely to develop chemoresistant disease, and novel therapeutic strategies will be necessary to cure these patients. Evidence on how to properly administer surgery and radiotherapy at relapse is more fragmentary. The authors have reviewed the available experiences concerning the treatment of recurrent WT, and have attempted to provide the most up-to-date recommendations regarding the optimal risk-based treatment for these patients.
authors: Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milano, Italy. filippo.spreafico@istitutotumori.mi.it
authors: Filippo
authors: F
authors: Spreafico
authors: Kathy
authors: K
authors: Pritchard Jones
authors: Marcio H
authors: MH
authors: Malogolowkin
authors: Christophe
authors: C
authors: Bergeron
authors: Juliet
authors: J
authors: Hale
authors: Jan
authors: J
authors: de Kraker
authors: Sandro
authors: S
authors: Dallorso
authors: Thomás
authors: T
authors: Acha
authors: Beatriz
authors: B
authors: de Camargo
authors: Jeffrey S
authors: JS
authors: Dome
authors: Norbert
authors: N
authors: Graf
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D019008:Drug Resistance, Neoplasm; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy*; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D009396:Wilms Tumor / Q000473:pathology / Q000628:therapy*