title: Multimodal therapy for adult Wilms' tumour: an experience from one centre.
abstract: BACKGROUND
  Wilms' tumour (WT) is very rare in adults but very common in children. Treatment guidelines for adult patients with WT are still insufficient. Some study groups recommend that therapeutic protocols for adults with WT (AWT) should follow the guidelines that have been established for children.
  
  
  OBJECTIVE
  To describe the clinical and pathological characteristics of AWT as well as the treatment protocols and outcomes for AWT at our treatment centre.
  
  
  METHODS
  Seven patients (5 females and 2 males) were diagnosed with AWT in our hospital between 2002 and 2009. The tumours were staged and the patients were treated according to the paediatric regimen recommended by the National Wilms' Tumor Study Group.
  
  
  RESULTS
  The median patient age at the time of diagnosis was 29 years (range, 16-37 years). Flank pain was the most common clinical presentation. One patient was in Stage I of disease development, two were in Stage II, two were in Stage III and two were in Stage IV. Anaplasia was present in 3 patients with Stage III or Stage IV disease. All of the patients but one underwent nephrectomy and 2 incomplete surgeries were performed. Seven patients received 2-drug or 3-drug chemotherapy (dactinomycin and vincristine and/or doxorubicin). Two patients with Stage III disease also received radiation therapy (a total dose of 3600 or 3960 cGy). Complete remission was achieved in 4 patients. Three patients (one with Stage III disease, 2 patients with Stage IV disease) died of their disease and those patients were all classified with an unfavourable histological type called anaplasia. With a median follow-up of 53.5 months (range, 40-102 months), the 3-year and 5-year overall survival rates were 57.1% (95% confidence interval, 20.4-93.8%).
  
  
  CONCLUSIONS
  The results of this report suggest that histological anaplasia might be an adverse prognostic factor for AWT. Proper application of the diagnostic and therapeutic regimens established for children may improve the prognosis of adult patients with WT.
authors.affiliation: Department of Oncology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Street, Shapingba, Chongqing, People's Republic of China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Li
authors.forename: Hai-Hui
authors.initials: HH
authors.lastname: Huang
authors.forename: Jian
authors.initials: J
authors.lastname: Shen
authors.forename: Jin-Yan
authors.initials: JY
authors.lastname: Jiang
authors.forename: Feng
authors.initials: F
authors.lastname: Pan
authors.forename: Song-Tao
authors.initials: ST
authors.lastname: Yu
authors.forename: Yu
authors.initials: Y
authors.lastname: Kang
authors.forename: Xiao-Xin
authors.initials: XX
authors.lastname: Zhao
authors.forename: Xiao-Chu
authors.initials: XC
authors.lastname: Yan
authors.forename: Hou-Jie
authors.initials: HJ
authors.lastname: Liang
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D009392:Nephrectomy / Q000379:methods / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D009396:Wilms Tumor / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
chemical_list: D003609:Dactinomycin; D014750:Vincristine; D004317:Doxorubicin