Wilms' tumour: trials and tribulation.

Surgery, radiotherapy and chemotherapy are currently the basis of multimodal treatment of Wilms' tumor. Surgery plays the central role in the management of this tumour and will cure 25% of patients if employed alone. Surgical mortality has been reduced to 1.5% at major centres and the most dangerous intra-operative complication is a venacaval tumour embolising into the pulmonary artery. Patients found to be initially inoperable who then have local and systemic therapy, followed by successful secondary surgery, have a reduced survival rate. Definite statements on bilateral tumours are difficult to make. The most fundamental determinants of survival are the histological characteristics of the tumour and the stage of the disease at presentation. Just as the quality of surgery has improved, so have radiotherapy techniques been refined. However, radiotherapy has been replaced by chemotherapy in many instances. The advent of chemotherapy has added to clinical success with a further improvement of survival figures by 25%. Chemotherapy is most effective in controlling micrometastases. However, it must be remembered that the treatment is toxic and needs skillful handling and modification.