[Wilm's tumor 1992. State of research and results of current therapeutic concepts].

Wilms' tumor is the most frequent and most important pediatric tumor in urologic oncology. In recent years the prognosis of Wilms' tumor has improved markedly and a cure rate of more than 80% can be achieved by means of standardized therapy protocols such as those established by the National Wilms' Tumor Study (NWTS), the Société Internationale d'Oncologie Pédiatrique (SIOP), and the German Society of Pediatric Oncology (GPO). However, since the number of long-term survivors is now expected to increase, serious long-term complications must be taken into account, especially after radiation therapy, and treatment modalities must be modified with due consideration for toxicity and late effects of treatment. Refinement of treatment protocols is therefore the main aim to two studies, SIOP-9/GPO and NWTS-4. In Germany, children with Wilms' tumor are now treated according to the SIOP-9/GPO protocol including preoperative chemotherapy. Preoperative chemotherapy can reduce tumor volume markedly, leading to a significantly higher proportion of children with stage I/II tumors at the time of surgery. Thus, postoperative chemotherapy can be reduced and radiation therapy avoided in children in whom stage III tumors would other wise have to be expected. Radiation therapy of pulmonary metastases can be restricted to children who have not responded to prior chemotherapy, whereas in others it seems tumor-free survival can be achieved by extirpation of the remaining pulmonary metastases alone following chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)