Adjuvant chemotherapy for favorable histology Wilm's tumor consists of either regimen EE-4A (vincristine and dactinomycin) or DD-4A (vincristine, dactinomycin, and doxorubicin) based on staging and the status of loss of heterozygosity (1p and 17q).
One special subset of patients with Wilm's tumor has been found to have a good outcome without chemotherapy. Specifically, patients younger than 2 years of age, with stage I FH Wilm's tumor that weighs less than 550 g have an estimated 5-year EFS of 84% (compared to 97% for those receiving EE-4A). Of the patients who receive no adjuvant therapy and relapse, the salvage rate (using DD-4A) exceeds that of those who are treated with EE-4A and relapse.
This protocol underlines importance of lymph node sampling (irrespective of gross appearance) as part of the surgical management of Wilm's tumor. In this case, if nodes are not sampled, the patient would not qualify for the no-chemotherapy option.
Reference:
Coran, A.G (2012) Pediatric Surgery. Philadelphia, PA. Elsevier
One special subset of patients with Wilm's tumor has been found to have a good outcome without chemotherapy. Specifically, patients younger than 2 years of age, with stage I FH Wilm's tumor that weighs less than 550 g have an estimated 5-year EFS of 84% (compared to 97% for those receiving EE-4A). Of the patients who receive no adjuvant therapy and relapse, the salvage rate (using DD-4A) exceeds that of those who are treated with EE-4A and relapse.
This protocol underlines importance of lymph node sampling (irrespective of gross appearance) as part of the surgical management of Wilm's tumor. In this case, if nodes are not sampled, the patient would not qualify for the no-chemotherapy option.
Reference:
Coran, A.G (2012) Pediatric Surgery. Philadelphia, PA. Elsevier
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