Current treatment for Wilms tumor: COG and SIOP standards

Abstract

BackgroundWilms tumor (WT) is the most common renal malignant tumor in children. It occurs primarily at preschool age. The purpose of this review is to present current standards of diagnosis and treatment of WT around the world.Data sourcesAll the recent literature on diagnosis and treatment of WT were searched and reviewed.ResultsMost cases with WT are sporadic. The current survival in patients with WT is high (90%). Involvement of mutidisciplinary collaborative groups in the diagnosis and treatment of WT. National Wilms Tumor Study Group (NWTSG)/Children’s Oncology Group (COG) and The International Society of Paediatric Oncology (SIOP) are two major guidelines used for the current management of WT worldwide. The major difference exists in the two guidelines is the timing of surgery: SIOP recommends using preoperative chemotherapy, and NWTSG/COG prefers using primary surgery before any adjuvant treatments.ConclusionsMost patients with WT have good overall survival outcomes. Further studies should be highlighted on how to use chemotherapy and radiotherapy under more accurate risk-stratified strategies. Surgeons must be more focusing on how to maximize preoperative and postoperative treatment possibilities for achieving optimal results of patients with WT.

Diagnostic accuracy and cytomorphological spectrum of Wilms tumour in fine needle aspiration biopsy cytology samples supplemented with cell blocks

“…The cytomorphology of anaplastic WT is well described 13 . The presence of any anaplasia on fine needle aspiration or core biopsy specimen would be considered as diffuse anaplasia as per COG guidelines 18 . Loke et al.…”

“…13 The presence of any anaplasia on fine needle aspiration or core biopsy specimen would be considered as diffuse anaplasia as per COG guidelines. 18 Loke et al in their comparative analysis of Asian versus non-Asian WT reported a frequency of unfavourable histology of just 4.1% in Asians as compared to 25% in non-Asians. 19 Cell blocks from FNA samples act as microbiopsies, and hence an FNA sample was designated as FNABC.…”

Many faces of Wilms Tumor: Recent advances and future directions

“…Preoperative chemotherapy by the COG has four regimes ( Table 6 ). The agents for chemotherapy commonly are doxorubicin plus dactinomycin and vincristine; if with anaplastic histology, chemotherapy then includes regimen I ( Table 6 ) [ 34 ].…”

“… SIOP Studies: The SIOP guideline recommends preoperative chemotherapy for all patients after diagnosis. For patients with unilateral localized tumor, 4-week pretreatment with vincristine (weekly) and dactinomycin (biweekly) is given; for patients with bilateral tumors, vincristine– dactinomycin for no longer than 9–12 weeks is recommended (doxorubicin is added for reinforcement in some patients); for patients with metastasis, a regimen including 6 weeks of vincristine–dactinomycin (like above) and doxorubicine on weeks 1 and 5 is given [ 34 ]. …”

“…Renal transplantation is recommended and is usually delayed until 1–2 years without evidence of relapse. The SIOP also suggests that preoperative chemotherapy should be limited to not longer than 12 weeks, with time intervals for evaluation fixed to 6 weeks [ 34 ]. A recently completed multi-institutional COG study (AREN0534) has standardized the approach to neoadjuvant therapy and timing of surgical resection, resulting in great benefit to patients with BWT.…”