The following are treatment options for stage III Wilms tumour. The healthcare team will suggest treatments based on your child’s needs and work with you to develop a treatment plan.
The healthcare team also considers the type of Wilms tumour when they plan treatments. Treatment for both favourable and unfavourable (anaplastic) histology usually involves surgery followed by radiation therapy to the abdomen and chemotherapy.
If the tumour can’t be removed safely because it is too large or has grown into nearby vessels or structures, a small tissue sample may be removed for biopsy and chemotherapy will be given. If chemotherapy doesn’t shrink the tumour, then radiation therapy may be given. Within 6 weeks of starting either chemotherapy or radiation therapy, doctors will assess the tumour to find out whether or not a radical nephrectomy can be done. If not, another 6 weeks of therapy is usually given before surgery is possible. If radiation therapy was not given before surgery, it will be given after surgery. Chemotherapy will be given again after surgery or radiation therapy.
Surgery is the primary treatment for both types of stage III Wilms tumour. The type of surgery is radical nephrectomy and removal of nearby lymph nodes. If the tumour can’t be removed safely at diagnosis, a small tissue sample will be removed for biopsy and chemotherapy is started. A biopsy may be repeated after 6 weeks of chemotherapy if the tumour isn’t responding to this treatment.
Radiation therapy to the abdomen is given after surgery, along with chemotherapy, for stage III Wilms tumour. Radiation may be given to one side, or flank, of the abdomen or to the entire abdomen. If the tumour can’t be removed with surgery and chemotherapy doesn’t shrink the tumour, radiation therapy may also be given before surgery.
Chemotherapy is used after surgery for stage III Wilms tumour that can be completely removed. If the tumour can’t be removed safely with surgery, chemotherapy may be given before surgery to shrink the tumour and then again after surgery. The type of chemotherapy most commonly used depends on the type of tumour.
Favourable histology tumours are treated with vincristine (Oncovin), doxorubicin (Adriamycin) and dactinomycin (Cosmegen, actinomycin-D). Chemotherapy is given for 25 weeks.
Favourable histology tumours with chromosome changes are treated with vincristine, doxorubicin and dactinomycin for 25 weeks. Some children receiving treatment in a clinical trial may also receive cyclophosphamide (Cytoxan, Procytox) and etoposide (Vepesid) in addition to these drugs.
Focal anaplastic tumours are treated with vincristine, doxorubicin and dactinomycin for 25 weeks.
Diffuse anaplastic tumours are treated with vincristine, doxorubicin, etoposide and cyclophosphamide for 25 weeks. Some children receiving treatment in a clinical trial may also receive carboplatin (Paraplatin, Paraplatin AQ) in addition to these drugs.
When cyclophosphamide is used, mesna (Uromitexan) is also given. Mesna helps protect the bladder from irritation from cyclophosphamide.
Many children with Wilms tumour will be treated in a clinical trial that is tailored to the stage and type of tumour. The clinical trial protocol outlines the chemotherapy drugs and dosages that are used. Find out more about clinical trials.