title: Management of Wilms Tumor: ICMR Consensus Document.
abstract: Wilms tumor (WT) is the most common renal tumor of childhood. Although multidisciplinary care including surgery, chemotherapy and radiotherapy have greatly improved the survival rates in WT, there is a scope for further improvement in India and other resource-poor settings. In resource-limited settings, the majority of patients present with large tumors, which may either be unresectable or risky to resect; making preoperative chemotherapy followed by delayed surgery the preferred approach. Histology and staging are used for risk stratification. The imaging procedure of choice is Contrast Enhanced CT scan (CECT) of thorax/ abdomen and pelvis, which is to be done at presentation, as well as for re-evaluation. Surgery is the cornerstone of treatment in WT and Radical Nephroureterectomy and Lymph node sampling is the procedure of choice, to be performed at week 5 in Non Metastatic WT and week 7 in Metastatic WT. WT is an extremely chemosensitive and radiosensitive tumor. Preoperative chemotherapy for Non Metastatic WT consists of 4 wk of Vincristine /Actinomycin and 6 wk of Vincristine /Actinomycin/ Adriamycin for Metastatic WT, with post-operative chemotherapy depending on stage and histology. Radiation therapy is recommended mainly in Stage III and Stage IV WT, with other indications given in the text. Other recommendations, such as treatment of WT in special situations and for supportive care are also detailed in the text.
authors.affiliation: Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India.
authors.forename: Maya
authors.initials: M
authors.lastname: Prasad
authors.affiliation: Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India. tusharsvora@yahoo.com.
authors.forename: Tushar
authors.identifier: http://orcid.org/0000-0001-5469-056X
authors.initials: T
authors.lastname: Vora
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Agarwala
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Laskar
authors.affiliation: Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India.
authors.forename: Brijesh
authors.initials: B
authors.lastname: Arora
authors.affiliation: Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Bansal
authors.affiliation: Department of Pediatric Hematology & Oncology, Rajiv Gandhi Cancer Institute & Research Center, Delhi, India.
authors.forename: Gauri
authors.initials: G
authors.lastname: Kapoor
authors.affiliation: Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India.
authors.forename: Girish
authors.initials: G
authors.lastname: Chinnaswamy
authors.affiliation: Department of Medical Oncology and Pediatric Oncology, Cancer Institute (W.I.A), Adyar, Chennai, India.
authors.forename: Venkatraman
authors.initials: V
authors.lastname: Radhakrishnan
authors.affiliation: NCD Division, Indian Council of Medical Research (ICMR), New Delhi, India.
authors.forename: Tanvir
authors.initials: T
authors.lastname: Kaur
authors.affiliation: Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: G K
authors.initials: GK
authors.lastname: Rath
authors.affiliation: Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
mesh_terms: D002648:Child; D003131:Combined Modality Therapy; D006801:Humans; D007194:India; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D009396:Wilms Tumor / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*
keywords: ICMR guidelines; Wilms tumor