Table 5.

Guidelines for chemotherapy in Wilms tumour.

NEOADJUVANT CHEMOTHERAPY
Indications:
•Bilateral Wilms tumour
•Inoperable tumour
•Intravascular extension into IVC above hepatic veins
•Tumour in solitary kidney
•Chronic Kidney Disease
•Predisposition syndromes
PREOPERATIVE CHEMOTHERAPY [7,8]
COG GUIDELINES	SIOP GUIDELINES
•The COG guideline recommends surgery as the initial therapy before chemotherapy.	•The SIOP guideline recommends preoperative chemotherapy for all patients after diagnosis.
•INDICATIONS: with inoperable WT; with a solitary kidney; with synchronous bilateral WT; tumour thrombus in the inferior vena cava extending above the level of the hepatic veins; tumour involving contiguous structures whereby removing the kidney tumour requiring removal of the other organs, such as spleen, pancreas, or colon and with extensive pulmonary metastases [16].	•For patients with unilateral localized tumour, 4-week pretreatment with vincristine (weekly) and dactinomycin (biweekly) is given.
•The agents for chemotherapy commonly are doxorubicin plus dactinomycin and vincristine; if with anaplastic histology, chemotherapy then includes regimen I.	•For patients with bilateral tumors, vincristine– dactinomycin for no longer than 9–12 weeks is recommended (doxorubicin is added for reinforcement in some patients).
	•For patients with metastasis, a regimen including 6 weeks of vincristine–dactinomycin (like above) and doxorubicine on weeks 1 and 5 is given.
POSTOPERATIVE CHEMOTHERAPY
COG GUIDELINES	SIOP GUIDELINES
•The COG recommends postoperative chemotherapy routinely used in all patients with WT except those at a very low risk: younger than 2 years at diagnosis with stage I favourable histology tumour weighing <550 g was sampled and confirmed negative lymph nodes.	•The SIOP recommends postoperative chemotherapy in all patients with WT except those with stage I low risk tumour.