WILMS' TUMOR: THE EVOLUTION OF A TREATMENT PROGRAM

Forty-four children with Wilms' tumor were seen in the combined Pediatric Tumor Clinic of the Babies Hospital, Columbia-Presbyterian Medical Center, from 1952 through 1965. This period of time was chosen for evaluation because the philosophy of the pediatric, surgical and radiotherapeutic members of the Tumor Clinic remained stable throughout this interval.

The evolution of the treatment program for Wilms' tumor is traced.

Careful analysis of patients with gross total tumor removal treated additionally with radiation therapy to the tumor bed versus such radiotherapy plus multiple prophylactic courses of Dactinomycin suggests a clinically important increase in survival rate with the latter program.

The value of routine postoperative irradiation of the tumor bed following gross total removal of the tumor is questioned in light of operative findings, the usual clinical appearance of pulmonary metastases rather than local recurrence, and early reports suggesting no decrease in survival in the absence of such irradiation.

Two year survival is again shown to be tantamount to cure. In contrast with most other reports, no statistically significant difference in survival rate could be shown at any age; this could not be attributed to the use of Dactinomycin in recent years.

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