Treatments for recurrent Wilms tumour

Recurrent Wilms tumour means that the cancer has come back after it has been treated. Most recurrences happen within 2 years of the initial diagnosis.

Treatment for recurrent Wilms tumour depends on:

• treatments your child has already received
• the type of Wilms tumour (whether it has a favourable or anaplastic histology)
• how much time has passed since the last treatment
• where the cancer recurs

Recurrent Wilms tumours are often treated based on their level of risk. Three levels of risk have been identified for recurrent Wilms tumour based on certain prognostic factors and outcomes after recurrence.

Standard-risk recurrent tumours have a favourable histology and recur after treatment with only vincristine or dactinomycin or both.

High-risk recurrent tumours recur after treatment with 3 or more chemotherapy drugs.

Very high-risk recurrent tumours have an anaplastic (unfavourable) or blastemal-predominant histology.

The following are treatment options for recurrent Wilms tumour. The healthcare team will suggest treatments based on your child’s needs and work with you to develop a treatment plan.

Standard-risk and high-risk recurrent Wilms tumours are usually removed with surgery, if possible. Surgery may also be done to confirm that the tumour has the same histology that it had when it was first diagnosed.

Find out more about surgery for Wilms tumour.

Chemotherapy uses drugs to destroy cancer cells.

Chemotherapy drug combinations that may be used for recurrent Wilms tumour depend on which chemotherapy drugs were already given and if the recurrent tumour has a favourable or anaplastic histology.

Standard-risk recurrent Wilms tumours may be treated with chemotherapy after surgery or if surgery is not possible. The drugs used may include vincristine, doxorubicin, cyclophosphamide, alternating with etoposide and carboplatin.

High-risk recurrent Wilms tumours may be treated with chemotherapy after surgery or if surgery is not possible. There is no standard chemotherapy treatment for high-risk recurrent Wilms tumours. One option is chemotherapy using cyclophosphamide and etoposide, alternating with carboplatin and etoposide. A stem cell rescue may be done following chemotherapy.

Very high-risk recurrent Wilms tumours arenʼt treated with a standard chemotherapy treatment. They are usually treated with more aggressive chemotherapy drugs, such as ifosfamide, carboplatin and etoposide. High-dose chemotherapy followed by a stem cell rescue may also be used, although this treatment is still being studied. Additional treatments may also be offered in a clinical trial setting.

Find out more about chemotherapy for Wilms tumour.

Radiation therapy uses high-energy rays or particles to destroy cancer cells.

Standard-risk and high-risk recurrent Wilms tumours may be treated with radiation therapy if the cancer has recurred in an area of the body that was not previously treated with radiation therapy. It may be given after surgery or if surgery is not possible.

Find out more about radiation therapy for Wilms tumour.

Children with cancer may be treated in a clinical trial. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Treatment is successful for many children with cancer, but in some cases it isnʼt. When cancer is advanced, the focus of treatment can change from cure to quality of life. There is help and support available. Find out more about when a cure is not possible.