Treatments for recurrent Wilms tumour

Recurrent Wilms tumour means that the cancer has come back after it has been treated. The following are treatment options for recurrent Wilms tumour. The healthcare team will suggest treatments based on your child’s needs and work with you to develop a treatment plan.

When planning treatment, the healthcare team will consider:

• treatments the child has already received
• the type of Wilms tumour (favourable or anaplastic histology)
• how much time has passed since treatment
• where the cancer recurs

Treatment of recurrent Wilms tumour may involve surgery, chemotherapy, radiation therapy or a stem cell transplant. Recurrent Wilms tumours are often treated based on their level of risk. Three levels of risk have been identified for recurrent Wilms tumour based on certain prognostic factors and outcomes after recurrence.

Standard-risk tumours have a favourable histology. The primary tumour was treated with vincristine (Oncovin) and dactinomycin (Cosmegen, actinomycin-D) only.

High-risk tumours also have a favourable histology. The primary tumour was treated with 3 or more chemotherapy drugs, with or without radiation therapy. Children with a short time to recurrence are also considered high risk.

Very high risk tumours have an anaplastic (unfavourable) histology. Children with a particular type of histology called blastemal predominant histology or a very short time to recurrence are also considered very high risk.

Treatment of standard-risk recurrent Wilms tumour

Children with standard-risk tumours are usually treated with surgery, if it is possible to remove the recurrence and to confirm that the tumour is the same histology. Radiation therapy and chemotherapy are given after surgery or if surgery is not possible. The drugs used are vincristine (Oncovin), doxorubicin (Adriamycin) and cyclophosphamide (Procytox), alternating with etoposide (Vepesid, VP-16) and cyclophosphamide.

Treatment of high-risk recurrent Wilms tumour

Children with high-risk tumours are usually treated with surgery, if it is possible to remove the recurrence. Radiation therapy and chemotherapy are given after surgery or if surgery is not possible. There is no standard treatment for high-risk Wilms tumours. One option is chemotherapy using cyclophosphamide and etoposide, alternating with carboplatin (Paraplatin, Paraplatin AQ) and etoposide. A stem cell transplant may be done following chemotherapy.

Treatment of very high risk recurrent Wilms tumour

There is no standard treatment plan for very high risk Wilms tumours. Children with very high risk tumours may be treated with more aggressive chemotherapy drugs, such as ifosfamide (Ifex), carboplatin and etoposide. They may also be given high-dose chemotherapy followed by a stem cell transplant. They may also be offered additional treatments through a clinical trial setting.

Surgery

Surgery may be done to confirm the diagnosis and to remove a local recurrence.

Radiation therapy

Radiation therapy may be used to treat a recurrence in areas that were not already treated with radiation therapy.

Chemotherapy

Chemotherapy combinations that may be used for recurrent Wilms tumour depend on which chemotherapy drugs the child has already received and if the recurrent tumour has a favourable or anaplastic histology.

Stem cell transplant

A stem cell transplant may be a treatment option for children with a poor prognosis. Although this treatment approach continues to be used in children with high-risk recurrent Wilms tumour, there is controversy as to whether high-dose chemotherapy followed by a stem cell transplant improves outcomes for children with Wilms tumour compared to treatment with intensive chemotherapy alone.

Clinical trials

Children with cancer may be treated in a clinical trial. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.