What`s new in Wilms tumor research and treatment?
Much of the research going on in the area of Wilms tumor is coordinated by the Children's Oncology Group (COG), whose main goal is to improve the treatment and quality of life of children with Wilms tumor and other types of cancer. COG is a large group of doctors, nurses, scientists, and other health professionals whose hard work has already saved the lives of thousands of children with Wilms tumor.
Biology of Wilms tumors
Research is continuing to unravel the mystery of how changes in certain genes cause Wilms tumors. Because different genes seem to be involved, this might be related to how aggressive certain tumors are likely to be.
As doctors have learned how to treat Wilms tumors more effectively, they have begun to look for ways to determine which children might be spared from more intensive treatment. They are also looking to for ways to identify children who might need more aggressive treatment to be cured. For example, recently, studies have shown that Wilms tumors with certain changes on chromosomes 1 or 16 seem to be more likely to recur after initial treatment. Doctors are now studying whether children with such tumors might benefit from more intensive treatment.
Researchers are also studying the molecular changes that seem to cause Wilms tumor cells to grow and spread. This may lead to treatments that are specifically targeted to correct or overcome these changes.
Treatment of Wilms tumors
Clinical trials continue to study ways to improve treatment for children with Wilms tumors. Earlier studies identified treatments that were very effective in curing Wilms tumors with the most favorable histology. Current clinical trials are studying ways to treat these cancers successfully while reducing side effects as much as possible. For example, studies are looking at whether young children with very favorable outlooks need any treatment other than surgery.
Many studies are looking to improve upon current chemotherapy treatments. For example, recent studies from Europe suggest that in some cases chemotherapy may not need to be continued as long as previously thought.
The outlook for patients with Wilms tumors with unfavorable histology is not as good, and the Children's Oncology Group is continuing to study more intensive and more effective treatments for these children. Newer chemotherapy drugs such as topotecan and irinotecan are now being tested.
Other studies are looking at bone marrow or peripheral blood stem cell transplants, which let doctors give higher doses of chemotherapy than the body normally could tolerate. This approach might help treat tumors that are not responding to standard treatments or that would otherwise have a poor prognosis.
Research on diagnostic procedures and treatment for Wilms tumor is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your child’s doctor.
New tumor markers. A tumor marker, also called a serum marker or biomarker, is a substance found in a person's blood, urine, or body tissue. Doctors in the United Kingdom recently discovered that children with Wilms tumor who have a recurrence all have active genes on one area of a specific chromosome (the 1q area). Children can be tested to see if their 1q genes are active, which can help doctors plan treatment. Once the specific genes are identified, it is possible that new tests may be developed to predict which children are likely to have a recurrence.
Genetics. A new Wilms tumor gene (WTX) has been identified on the X chromosome and plays a role in normal kidney development. This gene is not active in approximately one-third of children with Wilms tumor. Studies on the importance of this gene are ongoing.
New therapy combinations. Researchers are looking at whether patients with a favorable histology Wilms tumor who have metastases in the lungs need radiation therapy to the lungs if the lung tumors go away after six weeks of chemotherapy.
New treatment methods. Doctors are looking at the effect of using only surgery as a treatment for patients with small stage I tumors. After surgery, the patients are monitored closely for a recurrence.
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