Adult Wilms' tumor. Role of combined modality treatment.

Adults Wilms' tumor, unlike its pediatric counterpart, is extremely rare and highly lethal. Less than 200 cases have been reported in the world literature and a large proportion of these may not have been true Wilms' tumors. We report 3 cases seen at our institution who were treated with a multimodality approach, all three remaining alive without evidence of active disease at 6 years, 2.25 years and 8 months respectively from diagnosis. We also review results of multimodality management, emphasizing the poor outcome for stage III and IV tumors in spite of multi-agent chemotherapy. Alternative drugs, such as cisplatinum may have a role in management. Finally, we propose that prophylactic pulmonary irradiation may have a place in advanced stages of adult Wilms' tumor.