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Treatment and prognosis of Wilms tumor

Authors
Murali Chintagumpala, MD
Jodi A Muscal, MD
Section Editor
Alberto S Pappo, MD
Deputy Editor
Carrie Armsby, MD, MPH

INTRODUCTION

Wilms tumor is the most common renal malignancy in children [1]. Five-year overall survival rates have dramatically improved with multimodal therapy and now approach 90 percent.

The treatment and outcome of Wilms tumor will be reviewed here. The epidemiology, presentation, diagnosis, and staging of Wilms tumor are discussed separately. (See "Presentation, diagnosis, and staging of Wilms tumor".)

PROGNOSTIC FACTORS

Several prognostic factors at the time of initial diagnosis are associated with an increased risk of tumor recurrence or death, and include:

Tumor histology

Tumor stage

                          

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Literature review current through: Aug 2016. | This topic last updated: Feb 22, 2016.
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References
Top
  1. Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2012, National Cancer Institute. Bethesda, MD, based on November 2014 SEER data submission, posted to the SEER web site, April 2015. Available at: http://seer.cancer.gov/csr/1975_2012/results_merged/sect_29_childhood_cancer_iccc.pdf (Accessed on December 06, 2015).
  2. Zuppan CW, Beckwith JB, Luckey DW. Anaplasia in unilateral Wilms' tumor: a report from the National Wilms' Tumor Study Pathology Center. Hum Pathol 1988; 19:1199.
  3. D'Angio GJ, Evans A, Breslow N, et al. The treatment of Wilms' tumor: results of the Second National Wilms' Tumor Study. Cancer 1981; 47:2302.
  4. Breslow N, Churchill G, Beckwith JB, et al. Prognosis for Wilms' tumor patients with nonmetastatic disease at diagnosis--results of the second National Wilms' Tumor Study. J Clin Oncol 1985; 3:521.
  5. Faria P, Beckwith JB, Mishra K, et al. Focal versus diffuse anaplasia in Wilms tumor--new definitions with prognostic significance: a report from the National Wilms Tumor Study Group. Am J Surg Pathol 1996; 20:909.
  6. Bonadio JF, Storer B, Norkool P, et al. Anaplastic Wilms' tumor: clinical and pathologic studies. J Clin Oncol 1985; 3:513.
  7. Dome JS, Cotton CA, Perlman EJ, et al. Treatment of anaplastic histology Wilms' tumor: results from the fifth National Wilms' Tumor Study. J Clin Oncol 2006; 24:2352.
  8. van den Heuvel-Eibrink MM, van Tinteren H, Bergeron C, et al. Outcome of localised blastemal-type Wilms tumour patients treated according to intensified treatment in the SIOP WT 2001 protocol, a report of the SIOP Renal Tumour Study Group (SIOP-RTSG). Eur J Cancer 2015; 51:498.
  9. Weirich A, Leuschner I, Harms D, et al. Clinical impact of histologic subtypes in localized non-anaplastic nephroblastoma treated according to the trial and study SIOP-9/GPOH. Ann Oncol 2001; 12:311.
  10. Aoba T, Urushihara N, Fukumoto K, et al. Relapse of unilateral favorable histology Wilms' tumor: significant clinicopathological factors. J Pediatr Surg 2012; 47:2210.
  11. Vujanić GM, Sandstedt B, Harms D, et al. Revised International Society of Paediatric Oncology (SIOP) working classification of renal tumors of childhood. Med Pediatr Oncol 2002; 38:79.
  12. Metzger ML, Dome JS. Current therapy for Wilms' tumor. Oncologist 2005; 10:815.
  13. Green DM, Breslow NE, Beckwith JB, et al. Treatment outcomes in patients less than 2 years of age with small, stage I, favorable-histology Wilms' tumors: a report from the National Wilms' Tumor Study. J Clin Oncol 1993; 11:91.
  14. Green DM, Breslow NE, Beckwith JB, et al. Effect of duration of treatment on treatment outcome and cost of treatment for Wilms' tumor: a report from the National Wilms' Tumor Study Group. J Clin Oncol 1998; 16:3744.
  15. Blute ML, Kelalis PP, Offord KP, et al. Bilateral Wilms tumor. J Urol 1987; 138:968.
  16. Montgomery BT, Kelalis PP, Blute ML, et al. Extended followup of bilateral Wilms tumor: results of the National Wilms Tumor Study. J Urol 1991; 146:514.
  17. Grundy PE, Telzerow PE, Breslow N, et al. Loss of heterozygosity for chromosomes 16q and 1p in Wilms' tumors predicts an adverse outcome. Cancer Res 1994; 54:2331.
  18. Perlman EJ, Grundy PE, Anderson JR, et al. WT1 mutation and 11P15 loss of heterozygosity predict relapse in very low-risk wilms tumors treated with surgery alone: a children's oncology group study. J Clin Oncol 2011; 29:698.
  19. Grundy PE, Breslow NE, Li S, et al. Loss of heterozygosity for chromosomes 1p and 16q is an adverse prognostic factor in favorable-histology Wilms tumor: a report from the National Wilms Tumor Study Group. J Clin Oncol 2005; 23:7312.
  20. D'Angio GJ. Pre- or postoperative therapy for Wilms' tumor? J Clin Oncol 2008; 26:4055.
  21. Messahel B, Williams R, Ridolfi A, et al. Allele loss at 16q defines poorer prognosis Wilms tumour irrespective of treatment approach in the UKW1-3 clinical trials: a Children's Cancer and Leukaemia Group (CCLG) Study. Eur J Cancer 2009; 45:819.
  22. Spreafico F, Gamba B, Mariani L, et al. Loss of heterozygosity analysis at different chromosome regions in Wilms tumor confirms 1p allelic loss as a marker of worse prognosis: a study from the Italian Association of Pediatric Hematology and Oncology. J Urol 2013; 189:260.
  23. Gratias EJ, Jennings LJ, Anderson JR, et al. Gain of 1q is associated with inferior event-free and overall survival in patients with favorable histology Wilms tumor: a report from the Children's Oncology Group. Cancer 2013; 119:3887.
  24. Segers H, van den Heuvel-Eibrink MM, Williams RD, et al. Gain of 1q is a marker of poor prognosis in Wilms' tumors. Genes Chromosomes Cancer 2013; 52:1065.
  25. Dix DB, Fernandez CV, Chi YY, et al. Augmentation of therapy for favorable-histology Wilms Tumor with combined loss of heterozygosity of chromosomes 1p and 16q: A report from the Children’s Oncology Group studies AREN0532 and AREN0533. J Clin Oncol 2015; 33:abstr 10009.
  26. Sredni ST, Gadd S, Huang CC, et al. Subsets of very low risk Wilms tumor show distinctive gene expression, histologic, and clinical features. Clin Cancer Res 2009; 15:6800.
  27. Williams RD, Al-Saadi R, Chagtai T, et al. Subtype-specific FBXW7 mutation and MYCN copy number gain in Wilms' tumor. Clin Cancer Res 2010; 16:2036.
  28. Huang CC, Gadd S, Breslow N, et al. Predicting relapse in favorable histology Wilms tumor using gene expression analysis: a report from the Renal Tumor Committee of the Children's Oncology Group. Clin Cancer Res 2009; 15:1770.
  29. Gadd S, Huff V, Huang CC, et al. Clinically relevant subsets identified by gene expression patterns support a revised ontogenic model of Wilms tumor: a Children's Oncology Group Study. Neoplasia 2012; 14:742.
  30. Breslow NE, Palmer NF, Hill LR, et al. Wilms' tumor: prognostic factors for patients without metastases at diagnosis: results of the National Wilms' Tumor Study. Cancer 1978; 41:1577.
  31. Breslow N, Sharples K, Beckwith JB, et al. Prognostic factors in nonmetastatic, favorable histology Wilms' tumor. Results of the Third National Wilms' Tumor Study. Cancer 1991; 68:2345.
  32. Arrigo S, Beckwith JB, Sharples K, et al. Better survival after combined modality care for adults with Wilms' tumor. A report from the National Wilms' Tumor Study. Cancer 1990; 66:827.
  33. Reinhard H, Aliani S, Ruebe C, et al. Wilms' tumor in adults: results of the Society of Pediatric Oncology (SIOP) 93-01/Society for Pediatric Oncology and Hematology (GPOH) Study. J Clin Oncol 2004; 22:4500.
  34. Tournade MF, Com-Nougué C, Voûte PA, et al. Results of the Sixth International Society of Pediatric Oncology Wilms' Tumor Trial and Study: a risk-adapted therapeutic approach in Wilms' tumor. J Clin Oncol 1993; 11:1014.
  35. Tournade MF, Com-Nougué C, de Kraker J, et al. Optimal duration of preoperative therapy in unilateral and nonmetastatic Wilms' tumor in children older than 6 months: results of the Ninth International Society of Pediatric Oncology Wilms' Tumor Trial and Study. J Clin Oncol 2001; 19:488.
  36. Fuchs J, Kienecker K, Furtwängler R, et al. Surgical aspects in the treatment of patients with unilateral wilms tumor: a report from the SIOP 93-01/German Society of Pediatric Oncology and Hematology. Ann Surg 2009; 249:666.
  37. D'Angio GJ. Pre- or post-operative treatment for Wilms tumor? Who, what, when, where, how, why--and which. Med Pediatr Oncol 2003; 41:545.
  38. Pritchard-Jones K, Bergeron C, de Camargo B, et al. Omission of doxorubicin from the treatment of stage II-III, intermediate-risk Wilms' tumour (SIOP WT 2001): an open-label, non-inferiority, randomised controlled trial. Lancet 2015; 386:1156.
  39. Mitchell C, Pritchard-Jones K, Shannon R, et al. Immediate nephrectomy versus preoperative chemotherapy in the management of non-metastatic Wilms' tumour: results of a randomised trial (UKW3) by the UK Children's Cancer Study Group. Eur J Cancer 2006; 42:2554.
  40. Powis M, Messahel B, Hobson R, et al. Surgical complications after immediate nephrectomy versus preoperative chemotherapy in non-metastatic Wilms' tumour: findings from the 1991-2001 United Kingdom Children's Cancer Study Group UKW3 Trial. J Pediatr Surg 2013; 48:2181.
  41. Farber S. Chemotherapy in the treatment of leukemia and Wilms' tumor. JAMA 1966; 198:826.
  42. D'Angio GJ, Evans AE, Breslow N, et al. The treatment of Wilms' tumor: Results of the national Wilms' tumor study. Cancer 1976; 38:633.
  43. D'Angio GJ, Breslow N, Beckwith JB, et al. Treatment of Wilms' tumor. Results of the Third National Wilms' Tumor Study. Cancer 1989; 64:349.
  44. Green DM, Breslow NE, Beckwith JB, et al. Comparison between single-dose and divided-dose administration of dactinomycin and doxorubicin for patients with Wilms' tumor: a report from the National Wilms' Tumor Study Group. J Clin Oncol 1998; 16:237.
  45. Shamberger RC, Guthrie KA, Ritchey ML, et al. Surgery-related factors and local recurrence of Wilms tumor in National Wilms Tumor Study 4. Ann Surg 1999; 229:292.
  46. Frazier AL, Shamberger RC, Henderson TO, Diller L. Decision analysis to compare treatment strategies for Stage I/favorable histology Wilms tumor. Pediatr Blood Cancer 2010; 54:879.
  47. Shamberger RC, Anderson JR, Breslow NE, et al. Long-term outcomes for infants with very low risk Wilms tumor treated with surgery alone in National Wilms Tumor Study-5. Ann Surg 2010; 251:555.
  48. Fernandez CV, Perlmann E, Mullen EA, et al. Clinical outcome and biological predictors of relapse following nephrectomy only for very low risk Wilms tumor (VLR WT): A report from Children’s Oncology Group AREN0532. J Clin Oncol 2015; 33:10023.
  49. Green DM, Breslow NE, Beckwith JB, et al. Treatment with nephrectomy only for small, stage I/favorable histology Wilms' tumor: a report from the National Wilms' Tumor Study Group. J Clin Oncol 2001; 19:3719.
  50. Dix DB, Gratias EJ, Seibel Nita, et al. Omission of lung radiation in patients with stage IV favorable histology Wilms Tumor (FHWT) showing complete lung nodule response after chemotherapy: A report from Children’s Oncology Group study AREN0533. J Clin Oncol 2015; 33:10011.
  51. Bürger D, Moorman-Voestermans CG, Mildenberger H, et al. The advantages of preoperative therapy in Wilms' tumour. A summarised report on clinical trials conducted by the International Society of Paediatric Oncology (SIOP). Z Kinderchir 1985; 40:170.
  52. Lemerle J, Voute PA, Tournade MF, et al. Preoperative versus postoperative radiotherapy, single versus multiple courses of actinomycin D, in the treatment of Wilms' tumor. Preliminary results of a controlled clinical trial conducted by the International Society of Paediatric Oncology (S.I.O.P.). Cancer 1976; 38:647.
  53. Lemerle J, Voute PA, Tournade MF, et al. Effectiveness of preoperative chemotherapy in Wilms' tumor: results of an International Society of Paediatric Oncology (SIOP) clinical trial. J Clin Oncol 1983; 1:604.
  54. Hall G, Grant R, Weitzman S, et al. Predictors of surgical outcome in Wilms' tumor: a single-institution comparative experience. J Pediatr Surg 2006; 41:966.
  55. Dome JS, Graf N, Geller JI, et al. Advances in Wilms Tumor Treatment and Biology: Progress Through International Collaboration. J Clin Oncol 2015; 33:2999.
  56. Hamilton TE, Ritchey ML, Haase GM, et al. The management of synchronous bilateral Wilms tumor: a report from the National Wilms Tumor Study Group. Ann Surg 2011; 253:1004.
  57. ClinicalTrials.gov, Combination Chemotherapy and Surgery in Treating Young Patients With Wilms Tumor, Study Details. Available at: https://www.clinicaltrials.gov/ct2/show/NCT00945009 (Accessed on October 06, 2015).
  58. Ritchey ML, Green DM, Thomas PR, et al. Renal failure in Wilms' tumor patients: a report from the National Wilms' Tumor Study Group. Med Pediatr Oncol 1996; 26:75.
  59. Ritchey ML, Coppes MJ. The management of synchronous bilateral Wilms tumor. Hematol Oncol Clin North Am 1995; 9:1303.
  60. Horwitz JR, Ritchey ML, Moksness J, et al. Renal salvage procedures in patients with synchronous bilateral Wilms' tumors: a report from the National Wilms' Tumor Study Group. J Pediatr Surg 1996; 31:1020.
  61. Indolfi P, Jenkner A, Terenziani M, et al. Synchronous bilateral Wilms tumor: a report from the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP). Cancer 2013; 119:1586.
  62. Daw NC, Anderson JR, Hoffer FA, et al. A phase 2 study of vincristine and irinotecan in metastatic diffuse anaplastic Wilms tumor: Results from the Children’s Oncology Group AREN0321 study. J Clin Oncol 2014; 32:10032.
  63. Geller JI. Current standards of care and future directions for "high-risk" pediatric renal tumors: Anaplastic Wilms tumor and Rhabdoid tumor. Urol Oncol 2016; 34:50.
  64. Dix DB, Gratias EJ, Seibel N, et al. Treatment of stage IV favorable histology Wilms tumor with incomplete lung metastasis response after chemotherapy: A report from Children’s Oncology Group study AREN0533. J Clin Oncol 2014; 32:10001.
  65. Verschuur A, Van Tinteren H, Graf N, et al. Treatment of pulmonary metastases in children with stage IV nephroblastoma with risk-based use of pulmonary radiotherapy. J Clin Oncol 2012; 30:3533.
  66. Abu-Ghosh AM, Krailo MD, Goldman SC, et al. Ifosfamide, carboplatin and etoposide in children with poor-risk relapsed Wilms' tumor: a Children's Cancer Group report. Ann Oncol 2002; 13:460.
  67. de Camargo B, Melaragno R, Saba e Silva N, et al. Phase II study of carboplatin as a single drug for relapsed Wilms' tumor: experience of the Brazilian Wilms' Tumor Study Group. Med Pediatr Oncol 1994; 22:258.
  68. Ettinger LJ, Gaynon PS, Krailo MD, et al. A phase II study of carboplatin in children with recurrent or progressive solid tumors. A report from the Childrens Cancer Group. Cancer 1994; 73:1297.
  69. Kung FH, Desai SJ, Dickerman JD, et al. Ifosfamide/carboplatin/etoposide (ICE) for recurrent malignant solid tumors of childhood: a Pediatric Oncology Group Phase I/II study. J Pediatr Hematol Oncol 1995; 17:265.
  70. Loss JF, Santos PP, Leone LD, Brunetto AL. Outcome of pediatric recurrent and refractory malignant solid tumors following ifosfamide/carboplatin/etoposide (ICE): A phase II study in a pediatric oncology centre in Brazil. Pediatr Blood Cancer 2004; 42:139.
  71. Pein F, Pinkerton R, Tournade MF, et al. Etoposide in relapsed or refractory Wilms' tumor: a phase II study by the French Society of Pediatric Oncology and the United Kingdom Children's Cancer Study Group. J Clin Oncol 1993; 11:1478.
  72. Pein F, Tournade MF, Zucker JM, et al. Etoposide and carboplatin: a highly effective combination in relapsed or refractory Wilms' tumor--a phase II study by the French Society of Pediatric Oncology. J Clin Oncol 1994; 12:931.
  73. Pinkerton CR, Pritchard J. A phase II study of ifosfamide in paediatric solid tumours. Cancer Chemother Pharmacol 1989; 24 Suppl 1:S13.
  74. Pratt CB, Horowitz ME, Meyer WH, et al. Phase II trial of ifosfamide in children with malignant solid tumors. Cancer Treat Rep 1987; 71:131.
  75. Pratt CB, Douglass EC, Etcubanas E, et al. Clinical studies of ifosfamide/mesna at St Jude Children's Research Hospital, 1983-1988. Semin Oncol 1989; 16:51.
  76. Saylors RL 3rd, Stewart CF, Zamboni WC, et al. Phase I study of topotecan in combination with cyclophosphamide in pediatric patients with malignant solid tumors: a Pediatric Oncology Group Study. J Clin Oncol 1998; 16:945.
  77. Schwartzman E, Scopinaro M, Angueyra N. Phase II study of ifosfamide as a single drug for relapsed paediatric patients. Cancer Chemother Pharmacol 1989; 24 Suppl 1:S11.
  78. Tournade MF. A phase II study of ifosfamide in the treatment of relapses in Wilms' tumor. Cancer Chemother Pharmacol 1989; 24 Suppl 1:S31.
  79. Cotton CA, Peterson S, Norkool PA, et al. Early and late mortality after diagnosis of wilms tumor. J Clin Oncol 2009; 27:1304.
  80. Irtan S, Jitlal M, Bate J, et al. Risk factors for local recurrence in Wilms tumour and the potential influence of biopsy - the United Kingdom experience. Eur J Cancer 2015; 51:225.
  81. Pritchard-Jones K, Moroz V, Vujanic G, et al. Treatment and outcome of Wilms' tumour patients: an analysis of all cases registered in the UKW3 trial. Ann Oncol 2012; 23:2457.
  82. Ehrlich PF, Anderson JR, Ritchey ML, et al. Clinicopathologic findings predictive of relapse in children with stage III favorable-histology Wilms tumor. J Clin Oncol 2013; 31:1196.
  83. Coppes MJ, Arnold M, Beckwith JB, et al. Factors affecting the risk of contralateral Wilms tumor development: a report from the National Wilms Tumor Study Group. Cancer 1999; 85:1616.
  84. Green DM, Cotton CA, Malogolowkin M, et al. Treatment of Wilms tumor relapsing after initial treatment with vincristine and actinomycin D: a report from the National Wilms Tumor Study Group. Pediatr Blood Cancer 2007; 48:493.
  85. Malogolowkin M, Cotton CA, Green DM, et al. Treatment of Wilms tumor relapsing after initial treatment with vincristine, actinomycin D, and doxorubicin. A report from the National Wilms Tumor Study Group. Pediatr Blood Cancer 2008; 50:236.
  86. Dome JS, Liu T, Krasin M, et al. Improved survival for patients with recurrent Wilms tumor: the experience at St. Jude Children's Research Hospital. J Pediatr Hematol Oncol 2002; 24:192.
  87. Grundy P, Breslow N, Green DM, et al. Prognostic factors for children with recurrent Wilms' tumor: results from the Second and Third National Wilms' Tumor Study. J Clin Oncol 1989; 7:638.
  88. Dome JS, Bockhold CA, Li SM, et al. High telomerase RNA expression level is an adverse prognostic factor for favorable-histology Wilms' tumor. J Clin Oncol 2005; 23:9138.
  89. Ritchey ML, Shamberger RC, Haase G, et al. Surgical complications after primary nephrectomy for Wilms' tumor: report from the National Wilms' Tumor Study Group. J Am Coll Surg 2001; 192:63.
  90. Termuhlen AM, Tersak JM, Liu Q, et al. Twenty-five year follow-up of childhood Wilms tumor: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer 2011; 57:1210.
  91. van Dijk IW, Oldenburger F, Cardous-Ubbink MC, et al. Evaluation of late adverse events in long-term wilms' tumor survivors. Int J Radiat Oncol Biol Phys 2010; 78:370.
  92. Lange J, Peterson SM, Takashima JR, et al. Risk factors for end stage renal disease in non-WT1-syndromic Wilms tumor. J Urol 2011; 186:378.
  93. Smith GR, Thomas PR, Ritchey M, Norkool P. Long-term renal function in patients with irradiated bilateral Wilms tumor. National Wilms' Tumor Study Group. Am J Clin Oncol 1998; 21:58.
  94. Romao RL, Lorenzo AJ. Renal function in patients with Wilms tumor. Urol Oncol 2016; 34:33.
  95. Interiano RB, Delos Santos N, Huang S, et al. Renal function in survivors of nonsyndromic Wilms tumor treated with unilateral radical nephrectomy. Cancer 2015; 121:2449.
  96. Breslow NE, Norris R, Norkool PA, et al. Characteristics and outcomes of children with the Wilms tumor-Aniridia syndrome: a report from the National Wilms Tumor Study Group. J Clin Oncol 2003; 21:4579.
  97. Breslow NE, Collins AJ, Ritchey ML, et al. End stage renal disease in patients with Wilms tumor: results from the National Wilms Tumor Study Group and the United States Renal Data System. J Urol 2005; 174:1972.
  98. Grigoriev Y, Lange J, Peterson SM, et al. Treatments and outcomes for end-stage renal disease following Wilms tumor. Pediatr Nephrol 2012; 27:1325.
  99. Green DM, Grigoriev YA, Nan B, et al. Congestive heart failure after treatment for Wilms' tumor: a report from the National Wilms' Tumor Study group. J Clin Oncol 2001; 19:1926.
  100. Sorensen K, Levitt G, Sebag-Montefiore D, et al. Cardiac function in Wilms' tumor survivors. J Clin Oncol 1995; 13:1546.
  101. Tefft M, Mitus A, Das L, et al. Irradiation of the liver in children: review of experience in the acute and chronic phases, and in the intact normal and partially resected. Am J Roentgenol Radium Ther Nucl Med 1970; 108:365.
  102. Green DM, Norkool P, Breslow NE, et al. Severe hepatic toxicity after treatment with vincristine and dactinomycin using single-dose or divided-dose schedules: a report from the National Wilms' Tumor Study. J Clin Oncol 1990; 8:1525.
  103. Green DM, Peabody EM, Nan B, et al. Pregnancy outcome after treatment for Wilms tumor: a report from the National Wilms Tumor Study Group. J Clin Oncol 2002; 20:2506.
  104. Kalapurakal JA, Peterson S, Peabody EM, et al. Pregnancy outcomes after abdominal irradiation that included or excluded the pelvis in childhood Wilms tumor survivors: a report from the National Wilms Tumor Study. Int J Radiat Oncol Biol Phys 2004; 58:1364.
  105. Byrne J, Mulvihill JJ, Connelly RR, et al. Reproductive problems and birth defects in survivors of Wilms' tumor and their relatives. Med Pediatr Oncol 1988; 16:233.
  106. Breslow NE, Takashima JR, Whitton JA, et al. Second malignant neoplasms following treatment for Wilm's tumor: a report from the National Wilms' Tumor Study Group. J Clin Oncol 1995; 13:1851.
  107. Breslow NE, Lange JM, Friedman DL, et al. Secondary malignant neoplasms after Wilms tumor: an international collaborative study. Int J Cancer 2010; 127:657.
  108. Paulino AC, Wen BC, Brown CK, et al. Late effects in children treated with radiation therapy for Wilms' tumor. Int J Radiat Oncol Biol Phys 2000; 46:1239.
  109. Hogeboom CJ, Grosser SC, Guthrie KA, et al. Stature loss following treatment for Wilms tumor. Med Pediatr Oncol 2001; 36:295.
  110. Warwick AB, Kalapurakal JA, Ou SS, et al. Portal hypertension in children with Wilms' tumor: a report from the National Wilms' Tumor Study Group. Int J Radiat Oncol Biol Phys 2010; 77:210.
  111. Fernandez C, Geller JI, Ehrlich PF, et al. Renal tumors. In: Principles and Practice of Pediatric Oncology, 6th ed, Pizzo P, Poplack D (Eds), Lippincott Williams & Wilkins, St. Louis 2011. p.861.