TY - JOUR
T1 - Treatment of relapsed Wilms tumors
T2 - Lessons learned
AU - Spreafico, Filippo
AU - Jones, Kathy Pritchard
AU - Malogolowkin, Marcio H.
AU - Bergeron, Christophe
AU - Hale, Juliet
AU - De Kraker, Jan
AU - Dallorso, Sandro
AU - Acha, Thomás
AU - De Camargo, Beatriz
AU - Dome, Jeffrey S.
AU - Graf, Norbert
PY - 2009/12
Y1 - 2009/12
N2 - Treatment regimens for recurrent Wilms tumor (WT) are currently designed to include drugs that are not used during primary chemotherapy, using a risk-stratified approach. Therapy of recurrent disease depends on the nature of initial treatment, and of recognized prognostic indicators inherent in the primary tumor. Several highly effective chemotherapy regimens, including ifosfamide-carboplatin-etoposide, cyclophosphamide-etoposide and carboplatin-etoposide, are considered first treatment choice for recurrent disease. While intense-dose chemotherapy is uniformly accepted to treat high-risk recurrent WTs, the optimal therapy for standard-risk children has yet to be defined, owing to the small number of such patients and their relatively better prognosis compared with high-risk recurrences. Recurrent tumors among those defined as very-high risk are likely to develop chemoresistant disease, and novel therapeutic strategies will be necessary to cure these patients. Evidence on how to properly administer surgery and radiotherapy at relapse is more fragmentary. The authors have reviewed the available experiences concerning the treatment of recurrent WT, and have attempted to provide the most up-to-date recommendations regarding the optimal risk-based treatment for these patients.
AB - Treatment regimens for recurrent Wilms tumor (WT) are currently designed to include drugs that are not used during primary chemotherapy, using a risk-stratified approach. Therapy of recurrent disease depends on the nature of initial treatment, and of recognized prognostic indicators inherent in the primary tumor. Several highly effective chemotherapy regimens, including ifosfamide-carboplatin-etoposide, cyclophosphamide-etoposide and carboplatin-etoposide, are considered first treatment choice for recurrent disease. While intense-dose chemotherapy is uniformly accepted to treat high-risk recurrent WTs, the optimal therapy for standard-risk children has yet to be defined, owing to the small number of such patients and their relatively better prognosis compared with high-risk recurrences. Recurrent tumors among those defined as very-high risk are likely to develop chemoresistant disease, and novel therapeutic strategies will be necessary to cure these patients. Evidence on how to properly administer surgery and radiotherapy at relapse is more fragmentary. The authors have reviewed the available experiences concerning the treatment of recurrent WT, and have attempted to provide the most up-to-date recommendations regarding the optimal risk-based treatment for these patients.
KW - Chemotherapy
KW - Pediatric renal tumor
KW - Relapse
KW - Wilms tumor
UR - http://www.scopus.com/inward/record.url?scp=73349125771&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=73349125771&partnerID=8YFLogxK
U2 - 10.1586/ERA.09.159
DO - 10.1586/ERA.09.159
M3 - Article
C2 - 19954292
AN - SCOPUS:73349125771
VL - 9
SP - 1807
EP - 1815
JO - Expert Review of Molecular Diagnostics
JF - Expert Review of Molecular Diagnostics
SN - 1473-7159
IS - 12
ER -