Death of children with Wilms tumor is invariably due to lung metastases. Characteristically, the lungs are the first sites involved in the process of dissemination, and often the only site, although liver, brain, and rarely, bony deposits are seen. Dactinomycin is the end of a long odyssey in search of a means to prevent metastases and to achieve better survival. The credit for advancing and introducing surgical, radiotherapeutic, and chemotherapeutic approaches in controlling this disease and curing the patient belongs to the group at Boston Children's Hospital. It is an important "success story" with which to be familiar since the management of Wilms' tumor forms one of the cornerstones on which the philosophy and principles of caring for childhood cancers in general have been erected.
The primary concern in Wilms' tumor is preventing its dissemination. As soon as the child with a suspected Wilms' tumor has been admitted to the
Rubin P. Comment: The Prevention of Metastases. JAMA. 1968;204(11):989–990. doi:10.1001/jama.1968.03140240045013
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