Update Course Rewind: Updates in Wilms Management 2024
hosted by Dr. Lizzie Lee · StayCurrentMD
Part of
Wilms Tumor 20 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
European colleagues following SIOP guidelines would offer chemotherapy without biopsy for Wilms tumor.
At COG (Children's Oncology Group) sites in North America, the approach would be resection and diagnosis.
Doxorubicin would be added to chemotherapy even for a low stage tumor under certain conditions.
Doxorubicin is added when there is loss of heterozygosity at 1P and 16Q.
Loss of heterozygosity at 1P and 16Q shows higher recurrence in Wilms tumor.
For surgeons, there will be more waiting for the biology results before determining if chemotherapy is needed, affecting decisions about port placement.
It is not accurate to tell patients that if they are less than 2 years of age and the tumor is less than 550g, they will not need chemotherapy, because biology studies may require adding chemotherapy.
Chemotherapy must be added if there is loss of heterozygosity at 1P and 16Q.
Even in stage 1 favorable histology, chemotherapy is still added if there is loss of heterozygosity at 1P and 16Q.
Loss of heterozygosity is the loss of genetic diversity in tumor cells and can indicate more aggressive disease in Wilms tumor.
Gain of 1Q refers to an extra copy of a section of chromosome 1, which is linked to worse outcomes in some cancers.
According to Children's Oncology Group updates, adverse biologic factors are associated with worse prognosis in stage 2 patients, but not in stage 1 favorable histology Wilms tumor patients.
The North American COG approach often involves immediate surgery, while the European SIOP approach typically starts with chemotherapy before surgery.
Genetic markers like loss of heterozygosity at specific chromosomes can indicate a higher risk of cancer recurrence and guide decisions about adding chemotherapy treatments.