Chemotherapy for Wilms Tumors

When might chemotherapy be used for Wilms tumors?

Most children with Wilms tumors will get chemo at some point during their treatment. (Some children with very low risk tumors might not need it.)

In the United States and Canada, chemo is usually given after surgery for a Wilms tumor. Sometimes it may be needed before surgery, to shrink a tumor and make the operation possible.

In Europe and some other parts of the world, chemo is often given before surgery and continued afterward.

There seems to be no difference in the results from these approaches.

In either case, the type and amount of chemo given depends on the Wilms tumor’s stage and histology.

Which chemo drugs are used to treat Wilms tumors?

A combination of chemo drugs is used to treat children with Wilms tumors. The chemo drugs used most often are:

• Actinomycin D (dactinomycin)
• Vincristine

For tumors at more advanced stages, tumors with anaplastic histology, or tumors that recur (come back) after treatment, other chemo drugs might also be used, such as:

• Doxorubicin (Adriamycin)
• Cyclophosphamide
• Etoposide
• Irinotecan
• Carboplatin
• Ifosfamide
• Topotecan

How is chemo for a Wilms tumor given?

Chemo drugs for Wilms tumors are infused into the blood. This is done either through a vein (IV) or through a central venous catheter (a thin tube inserted into a large blood vessel during surgery).

Different drugs, doses, and lengths of treatment might be used, depending on the type and stage of the Wilms tumor and the child’s age. Most often, the drugs are given once a week for at least several months.

Chemo is usually given by a nurse in a clinic or in the outpatient section of the hospital. Some children with Wilms tumors might need to stay in the hospital while getting chemo, but usually this is not needed.

Possible side effects of chemo

Chemo drugs can affect cells other than cancer cells, which can lead to side effects.

The side effects of chemo depend on which drugs are given, the doses used, and the length of treatment.

Short-term side effects

Possible short-term side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea or constipation
• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue or extreme tiredness (from having too few red blood cells)

Your child’s doctor and treating team will watch closely for any side effects that develop. There are often ways to lessen these effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.

Ask your child’s cancer care team about medicines to help reduce side effects. Be sure to let them know if your child has any side effects, so they can be managed.

Drug-specific side effects

Along with the effects listed above, some chemo drugs used to treat Wilms tumors can have specific side effects. For example:

• Vincristine can damage nerves. Some patients may have tingling, numbness, weakness, or pain, particularly in the hands and feet. (This is called peripheral neuropathy.)
• Doxorubicin can damage the heart. The risk of this happening goes up as the total amount of the drug given goes up. Doctors try to limit this risk as much as possible by not giving more than the recommended doses. They also give the drug dexrazoxane to help protect the heart, and they check the heart during treatment with a test called an echocardiogram (an ultrasound of the heart).
• Cyclophosphamide can damage the bladder, which can cause blood in the urine. This risk can be lowered if the drug is given with plenty of fluids and with a drug called mesna, which helps protect the bladder.

Lab tests to check for chemo side effects

Before each chemo session, the cancer care team will get blood tests to check blood cell levels and see how well your child’s liver and kidneys are working. If there are problems, chemo might need to be delayed or the doses reduced.

Long-term side effects of chemo

Some chemo drugs have possible long-term effects. This is one of the major challenges children might face after cancer treatment.

For example:

• If your child is given doxorubicin, there is a chance it could damage their heart. Your child’s cancer care team will carefully watch the doses used. They will also check your child’s heart function with imaging tests.
• Some chemo drugs can increase the risk of developing a second type of cancer (such as leukemia) years after the Wilms tumor is cured. But this small increase in risk has to be weighed against the importance of chemo in treating the Wilms tumor.
• Some drugs might also affect fertility (the ability to have children) years later.

See Living as a Wilms Tumor Survivor for more on the possible long-term effects of treatment.