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Management of Wilms Tumor: ICMR Consensus Document

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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.

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Acknowledgements

This article is prepared as an outcome of Indian Council of Medical Research (ICMR) Sub-Committee on Pediatric Lymphomas and Solid Tumors coordinated by the Division of Non-Communicable Diseases, ICMR.

Contributions

MP and TV wrote the manuscript. All the authors contributed with discussion, expert opinions and final consensus. SB will act as guarantor for the paper.

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Authors and Affiliations

  1. Department of Pediatric Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India

    Maya Prasad, Tushar Vora, Brijesh Arora & Girish Chinnaswamy

  2. Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India

    Sandeep Agarwala

  3. Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India

    Siddharth Laskar

  4. Pediatric Hematology Oncology Unit, Department of Pediatrics, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Deepak Bansal

  5. Department of Pediatric Hematology & Oncology, Rajiv Gandhi Cancer Institute & Research Center, Delhi, India

    Gauri Kapoor

  6. Department of Medical Oncology and Pediatric Oncology, Cancer Institute (W.I.A), Adyar, Chennai, India

    Venkatraman Radhakrishnan

  7. NCD Division, Indian Council of Medical Research (ICMR), New Delhi, India

    Tanvir Kaur

  8. Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India

    G. K. Rath

  9. Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India

    Sameer Bakhshi

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  1. Maya Prasad
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  2. Tushar Vora
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  3. Sandeep Agarwala
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  8. Girish Chinnaswamy
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  9. Venkatraman Radhakrishnan
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  10. Tanvir Kaur
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  11. G. K. Rath
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Corresponding author

Correspondence to Tushar Vora.

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ICMR organized the meeting and funded the travel.

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Prasad, M., Vora, T., Agarwala, S. et al. Management of Wilms Tumor: ICMR Consensus Document. Indian J Pediatr 84, 437–445 (2017). https://doi.org/10.1007/s12098-017-2305-5

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  • DOI: https://doi.org/10.1007/s12098-017-2305-5

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