Establishment of new therapeutic protocol for pediatric renal tumor according to the new risk classification

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We analyzed methylation status of tumor suppressor gene RASSF1A in 84 Wilms tumors and found out that it was significantly associated with a poor outcome. Moreover, we analyzed the mutation of WTX gene and revealed that this also was significantly associated with a poor outcome. Therefore these biomarkers were considered be candidates of the new biomarkers for risk classification to create the new therapeutic protocols.The survival rate of bilateral Wilms tumors (BWT) has been improved; however, the results are not satisfactory in terms of the renal preservation. We reviewed the outcome of BWT registered in JWiTS. Bilateral nephron-sparing surgery (NSS) was achieved only in 10 of 28 cases (36%) and 10 children (40%) developed impaired renal function. The protocol should be changed to improve the rate of preservation of the renal parenchyma. Preoperative chemotherapy should be performed to shrink the tumors, and subsequent NSS should be carried out after a central imaging evaluation.