Pediatric Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133 Milano, Italy.
Expert Rev Anticancer Ther. 2009 Dec;9(12):1807-15. doi: 10.1586/era.09.159.
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.
复发性 Wilms 肿瘤（WT）的治疗方案目前旨在采用风险分层的方法，纳入在原发性化疗期间不使用的药物。复发性疾病的治疗取决于初始治疗的性质，以及原发性肿瘤固有的公认预后指标。几种高效的化疗方案，包括异环磷酰胺-卡铂-依托泊苷、环磷酰胺-依托泊苷和卡铂-依托泊苷，被认为是复发性疾病的首选治疗方案。虽然高强度化疗被普遍认为可用于治疗高危复发性 WT，但由于此类患者数量较少，且与高危复发相比，其预后相对较好，因此尚未确定标准风险儿童的最佳治疗方法。在被定义为极高风险的患者中，复发性肿瘤可能会出现耐药性疾病，因此需要新的治疗策略来治愈这些患者。关于如何在复发时正确进行手术和放疗的证据更为零散。作者回顾了有关复发性 WT 治疗的现有经验，并试图就这些患者的最佳基于风险的治疗提供最新建议。
