Progress and controversies in modern treatment of Wilms' tumors.

During the past 25 years the treatment of Wilms' tumors has been refined owing to a series of thoroughly performed clinical studies. The overall prognosis is currently 80% (long-term cures), but different therapeutic issues are still discussed controversially, especially the question of preoperative treatment. A number of different drugs have proved effective in the treatment of Wilms' tumors. It remains to be determined as to which drug combinations are the most effective for which histologic subtype and which stage of disease. It seems that these questions can be answered only if further studies consequently implicate analyses of early and long-term toxicities. The same is true for analyses of peri- and postoperative complications. Radiotherapy plays a role in about 50% of cases. Special subtypes require modified strategies, and the optimal treatment for high-risk histologic types has not yet been found.