Natural history and treatment of Wilms's tumour: an analysis of 335 cases occurring in England and Wales 1962-6.

Hospital records and other data relating to Wilms's tumour were analysed to elucidate both thenatural history of the disease and the effects of treatment, with special reference to actinomycin D. The age of maximum incidence was about 18 months; left-sided tumours were significantly more common than right-sided ones.Prognosis was related to stage of the disease at the initial operation and to the occurrence of metastasis. The three-year survival rate for cases having a nephrectomy was 35%; no child who did not have a nephrectomy survived.Recurrence of the tumour was observed in two-thirds of the cases, almost always within two years of the initial treatment, irrespective of the child's age. The three-year survival rate for this group was 11%.The effects of radiotherapy and chemotherapy are considered in detail. Very little improvement in survival rate could be ascribed to actinomycin D. The reasons for this and for the variations found in earlier reports on selected cases are possibly the addition of other components of treatment and differences in drug regimens. The findings suggest the need for controlled clinical trials.