Monitoring

Close follow-up for at least 60 months is necessary to identify local relapse, contralateral Wilms tumor development, distant metastases, and serious, rare adverse effects of treatment such as secondary malignancies, renal failure, congestive heart failure, restrictive lung disease, and infertility.[169][170][171][172]

Tumor surveillance includes abdominal and chest computed tomography, and should be obtained serially until 18 months after completion of therapy. Abdominal ultrasound and chest x-ray are sufficient to identify any late relapses thereafter.[117][121]​​​[132]​​[173]​​ For patients with favorable histology Wilms tumor, a less aggressive imaging surveillance strategy may be appropriate.[72]

Echocardiogram (identifies anthracycline-induced cardiac adverse effects) and creatinine clearance should be obtained serially (i.e., at diagnosis, midway through treatment, at the end of therapy, and then at a frequency based on cumulative anthracycline dose [based on doxorubicin isotonic equivalent dose]). Follow-up echocardiograms are recommended:[148]

  • Every 5 years for patients with a cumulative anthracycline dose of 100-249 mg/square meter of body surface area

  • Every 2 years for patients with a cumulative anthracycline dose of ≥250 mg/square meter of body surface area

If patient has bilateral Wilms tumor, an associated genetic syndrome, or if nephrogenic rests are identified, a lengthier surveillance regimen is advisable.[102][174][175]

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