Wilms Tumor

#willmsumor #paediatriconcology

What are the indication for neoadjuvant chemo in Wilms TUMOR

Is biopsy of contralateral kidney required

Do we have to do a formal lymph node dissection

Do all patient need post of chemo / Radiotherapy

Is there any difference between radical Nx for RCC and Wilms TUMOR

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  • Venugopal P
    Venugopal P
    02 Feb 2020 11:19:18 AM

    Dear All,

    Nitesh has posted a case of Wilms Tumour with excellent Images. The answers for his questions can be answered by reading the materials provided. Govt of India has prepared a guideline for Wilm’s tumour and I am providing the main aspects of the guideline. I have added some additional facts also in the PDF provided. I am also providing the NWTSG/SIOP Protocols as well.

    Additionally I am providing the latest Protocol that will have to use for Wilm’s tumour called ‘UMBRELLA Protocol’ introduced by SIOP and RSTG. This has incorporated some aspects of NWTS protocol as well.


    I am providing an article on Current Treatment of Wilms Tumour based on COG and SIOP protocols.


    I am sure all these put together will enhance our knowledge as regards Wilms Tumour

    With warm Regards,



    View Document

  • Venugopal P
    Venugopal P
    02 Feb 2020 11:23:08 AM

    I am providing the Govt of India Guideline and few other aspects


    View Document

  • Dr. Anil Takvani
    Dr. Anil Takvani
    02 Feb 2020 03:08:00 PM

    Dear All,

    Prof. Venugopal Sir has written very elaborately on Nitesh's post on Wilm's tumour.

    Nitesh has raised five relevant issues;

    1. Indications for neoadjuvant chemotherapy:

    As Sir has mentioned Europe and US differs in practice.

    In Europe as they follow SIOP, neoadjuvant chemotherapy is almost a rule.

    In US as they follow COG/NWTSG , surgery/debulking surgery is prior to chemotherapy.

    In my practice I go ahead with surgical removal (complete or maximum possible) with lymphnodes sampling followed by chemotherapy. As many of the time I lose patients during chemotherapy or after chemotherapy on issue of compliance and tolerance. 

    Secondly results are not different.

    2. Biopsy of contra lateral I have not practiced.

    3. Selective lymphnode dissection for proper staging and histopathology

    4. All patients need chemotherapy (neonates and infants in almost half of the dose.

    Radiotherapy to tumour bed or to entire abdomen if histopathology unfavourable.

    5. Radical treatment for RCC means you are not leaving anything behind. In Wilm's tumour debulking is effective as we discussed in first para.

    We have an excellent case from Nitesh, hoping for extensive discussions...


    Thanks & Regards


  • Venugopal P
    Venugopal P
    05 Feb 2020 05:36:46 PM

    Dear All,

    In continuation of the discussion on Wilms tumour, I am posting an article (PDF) on ‘Accuracy of Staging of Wilm’s Tumour’ which could throw additional light on the subject. The authors mention that Stage 1, 4 and 5 can be easily staged but the same is not true as regards stages 2 and 3.

    With warm regards,



    View Document

  • shriram joshi
    shriram joshi
    16 Feb 2020 08:38:11 PM

    I had a chat with Paediatric Oncosurgeon of Tata Memorial Hospital, who have a largest experience in Wilm's Tumour literally hundreds. They have very simple protocol unlike the protocol described above by Venu. Their approach as I understood after discussion are 

    1. No biopsy or chemotherapy prior to surgery except in 
        a. if the tumour is crossing the midline, b. there are glands in  retroperitonium on imaging, c. there is perinephric fluffiness suggesting spread, d. bilateral wilm's tumour.
    2. The two preferred chemotherapeutic drugs are actinomycin and vincristine. They find our patients tolerate these well. It is when you add doxyrubicin or radiotherapy that problem of managing the child starts. 
    3. Tata results compare very well with international standards. 
    May be Anil you can ask Dr. Sadiq, paediatric oncosurgeon from Tata Memorial Hospital to comment on this case .
    Lastly I understand we need pop ups to maintain the web site, but there popping while I am writing a discussion is very disturbing and breaks the chain of thought. 
    They can come in the beginning or at the end but not while writing a response.

  • Dr. Anil Takvani
    Dr. Anil Takvani
    16 Feb 2020 10:01:52 PM

    Sir,  we have not kept pop ups. 

    I will inquire web person. 
    Will contact Dr.  Sadie. 
    But I am more or less follow the same pathway in treatment of Wilm's tomor. 

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