Treatment and prognosis of 32 patients with bilateral Wilms' tumor

During the 29-year period 1955–1983, 32 children with bilateral Wilms' tumor were treated at the Hospital for Sick Children, Toronto (HSC) and the Royal Children's Hospital, Melbourne (RCH). Those whose tumors presented synchronously (n=22) had a good prognosis: 15 (68%) are alive and disease-free 12 to 204 months post-diagnosis with a median follow-up of 96 months. There were no deaths due to metastases. The asynchronous group (n=10) had a poor prognosis: only 3 are disease-free survivors, 2 long-term and 1 who has survived 17 months following diagnosis of the contralateral tumor. Five of the 7 deaths were due to metastases, possibly related to the immunosuppressive effect of the additional chemo/radiotherapy given for the separate treatment of both tumors. The poor prognosis could not be attributed to extent of disease or unfavourable histology as only 2 were stage IV at diagnosis of the second tumor and none had anaplastic histology. We recommend renal ultrasound and abdominal computerized axial tomography for an accurate diagnosis of synchronous Wilms' tumors, particularly in children at high risk for bilaterality, and for prolonged follow-up to detect asynchronous disease.