Chemotherapy for Wilms tumour

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. Most children with Wilms tumour have chemotherapy. The healthcare team will consider your child’s personal needs to plan the drugs, doses and schedules of chemotherapy. Your child may also receive other treatments.

Chemotherapy is given for different reasons. Your child may have chemotherapy to:

  • shrink a tumour before surgery (called neoadjuvant chemotherapy)
  • destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
  • destroy cancer cells in the body, relieve pain or control the symptoms of advanced Wilms tumour

Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the kidney.

Chemotherapy drugs used for Wilms tumour

Chemotherapy drugs used to treat Wilms tumour are:

  • vincristine (Oncovin)
  • dactinomycin (Cosmegen, actinomycin-D)
  • doxorubicin (Adriamycin)
  • cyclophosphamide (Procytox)
  • cisplatin
  • carboplatin (Paraplatin, Paraplatin AQ)
  • etoposide (Vepesid, VP-16)
  • irinotecan (Camptosar)

The most common chemotherapy drug combinations used to treat Wilms tumour are:

  • vincristine and dactinomycin
  • vincristine, dactinomycin and doxorubicin
  • vincristine, doxorubicin, etoposide and cyclophosphamide (with or without dactinomycin or carboplatin)

If Wilms tumour does not respond to drugs used in earlier treatments or if it comes back, the following drug combinations may be used:

  • vincristine, doxorubicin and cyclophosphamide
  • ifosfamide (Ifex), carboplatin and etoposide
  • cyclophosphamide and etoposide alternating with carboplatin and etoposide

Cyclophosphamide can irritate the bladder. When this chemotherapy drug is used, mesna (Uromitexan) may also be given to protect the bladder.

Side effects

Side effects can happen with any type of treatment for Wilms tumour, but every child’s experience is different. Some children have many side effects. Other children have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. Side effects can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

It is hard to say exactly which side effects a child will have, how long they will last and when the child will recover. A child’s body seems to handle chemotherapy better than an adult’s body. Children usually have less severe side effects and will often recover from them faster than adults.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your child’s overall health. Some common side effects of chemotherapy drugs used for Wilms tumour are:

Other side effects can develop months or years after treatment for Wilms tumour. Find out more about late effects of treatments for Wilms tumour.

Tell your child’s healthcare team if your child has these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help your child deal with them.

Information about specific cancer drugs

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Questions to ask about chemotherapy

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for your child, ask the healthcare team questions about chemotherapy.

Expert review and references

  • American Cancer Society. Treating Wilms Tumour. 2016.
  • American Society of Clinical Oncology. Wilms Tumor - Childhood. 2016.
  • Wilms' tumour (kidney cancer in childhood). Cancer Research UK. CancerHelp UK. Cancer Research UK; 2012.
  • Children's & Women's Health Centre of British Columbia . Kidney. British Columbia Children's Hospital - Oncology, Hematology and BMT. Children's & Women's Health Centre of British Columbia; 2003.
  • Children's Hospital Boston . Wilms tumor. Children's Hospital Boston - My Child Has.... Boston, MA: Children's Hospital Boston; 2007.
  • Cincinnati Children's Hospital Medical Center . Wilms tumor. Cincinnati Children's Hospital Medical Center - Cancer Conditions and Diagnoses. Cincinnati, OH: Cincinnati Children's Hospital Medical Center; 2007.
  • Duffey-Lind, E . Tumours of the kidney. Kline, N. E. (Ed.). Essentials of Pediatric Oncology Nursing: A Core Curriculum. 2nd ed. Association of Pediatric Oncology Nurses; 2004: 2.10:46-49.
  • Fernandez CV, Geller JI, Ehrlich PF et al . Renal Tumors. Pizzo PA & Poplack DG (eds.). Principles and Practice of Pediatric Oncology. 7th ed. Philadelphia: Wolters Kluwer; 2016: 29:753-768.
  • Wilms tumor. Janes-Hodder, H. & Keene, N. Childhood Cancer - A Parent's Guide to Solid Tumor Cancers. 2nd ed. O'Reilly; 2002: 9:137-149.
  • Macmillan Cancer Support. Wilms Tumour in Children. 2016.
  • National Cancer Institute. Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQ®) Patient Version. 2017.
  • National Cancer Institute. Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQ®) Health Professional Version. 2017.
  • Wilms tumor in children. National Childhood Cancer Foundation & Children's Oncology Group. CureSearch. Bethesda, MD: 2011.
  • Paulino, Arnold C. Medscape Reference: Wilms Tumor Treatment and Management. 2016:
  • St. Jude Children's Research Hospital . Solid tumor: Wilms tumor. St. Jude Children's Research Hospital - Disease Information. Memphis, TN: St. Jude Children's Research Hospital; 2008.
  • Wilms' Tumor: The Basics. University of Pennsylvania. OncoLink. Reviewed ed. University of Pennsylvania; 2008.