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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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.
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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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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