Advances in the treatment of Wilms' tumor.

The addition of chemotherapy to older standard treatment with surgery and radiotherapy has increased survival to more than 80% in localized Wilms' tumor, and about 50% in metastatic disease. Actinomycin-D and vincristine have proved to be the two most active agents. Multiple-course maintenance treatment with actinomycin-D has allowed fewer relapses, but not a significantly different survival rate than a single course of this drug. Use of actinomycin-D and vincristine in combination has been under study; initial indications show that the combination is superior to either drug employed singly. The need for postoperative radiotherapy in totally resected tumors confined to the kidney is also under study. Adriamycin is at present the most encouraging new drug that has had clinical trial.