Pediatr Blood Cancer 2014;61:1578–1583 Treatment of Wilms Tumor Using Carboplatin Compared to Therapy Without Carboplatin Can Acipayam, MD,* Gu ¨ lay Sezgin, MD, Ibrahim Bayram, MD, Sema Yılmaz, MD, Ays ¸e O ¨ zkan, MD, Defne Ay Tuncel, MD, Atila Tanyeli, MD, and Serhan Ku ¨ peli, MD, MSc INTRODUCTION Wilms tumor (WT) is the most common pediatric malignant primary renal tumor [1]. This renal cancer particularly affects children in the first 2 years of life. Overall survival (OS) rates in patients with WT have risen to 85% due to the ongoing success of clinical trials over the last 30 years. Treatment-associated morbidity has also declined. Duration and intensity of treatment depend on the stage of the disease and histopathological findings. WT treatments include pre-operative and post-operative vincristine and actinomy- cin-D, with or without doxorubicin or radiotherapy. Salvage chemotherapy involving ifosfamide, carboplatin, and etoposide (ICE protocol), in addition to high-dose chemotherapy regimens and autologous hemopoietic stem-cell rescue, are also available in relapsed patients [2]. Carboplatin entered into clinical use in 1981 [3]. It has since come to represent a practicable alternative to cisplatin for the treatment of various solid tumors. Carboplatin is a second- generation analog of cisplatin, with which it shares various structural and pharmacological characteristics. However, carbo- platin has a better toxicity profile and causes significantly less nephrotoxicity than cisplatin. Cisplatin is a much more emetogenic chemotherapeutic agent, compared to carboplatin. The dose- limiting factor in conventional carboplatin therapy is hematological toxicity, and the resulting thrombocytopenia is more severe than leukopenia or anemia [3,4]. In this study, carboplatin was used instead of actinomycin-D when the latter was unavailable for the treatment of patients with WT. The aim was to evaluate the results of carboplatin combination treatment modalities from our institution in Adana, Turkey. METHODS Forty-eight consecutive patients with WT treated between July 2005 and December 2011 were retrospectively included in the study. Data were obtained from patients’ medical charts. Written consent was obtained from the patient’s family or legal guardian. Since the study was not planned prospectively ethical committee approval could not be obtained before treatment began. We decided that treatment should not be continued with a deficient drug at a time when actinomycin-D was unavailable in Turkey, and carboplatin, used in relapsed Wilms tumor, was employed instead. The results of carboplatin therapy were good. We therefore thought that the scientific presentation of this research in the form of a paper would be of use to other physicians. Approval for the study was granted by the ethical committee. Such approval is not required for retrospective studies. Complete physical examination including blood pressure measurement, laboratory tests including urine analysis, complete blood count and blood biochemistry, cardiac evaluation with electrocardiogram (ECG), and echocardiography (ECHO), and imaging techniques including chest X-ray, abdominal ultrasonography (USG), Doppler USG, and abdominal computer- ized tomography (CT) were performed for each patient. CT scans were used to determine the origin of the tumor within the kidney, evaluate the possible presence of a second WT in the contralateral kidney, assess caval extension, and identify metastases. The combination of CT scan and USG was the most useful and accurate method for diagnosing and assessing patients before surgery. Histopathological classification and clinical staging were performed on the basis of the Turkish Pediatric Oncology Group (TPOG) system [5]. Clinical records were surveyed for all patients, and data including age, gender, and symptoms at presentation, sites of initial involvement, laboratory results, initial treatment, therapeutic response and date of diagnosis, date of first treatment, Background. Wilms tumor (WT) is the most common pediatric malignant primary renal tumor. One of the main drugs used in treatment is actinomycin-D. This was not readily available in Turkey at one time. Carboplatin was used in the primary treatment of WT in order to prevent delays in treatment. The aim of this study is to present the results of patients with WT receiving carboplatin or actinomycin- D therapy. Procedure. Forty-eight consecutive patients with WT treated between July 2005 and December 2011 were included in this retrospective study. The patients were treated according to Turkish Pediatric Oncology Group guidelines. Nineteen patients were treated with actinomycin-D and 29 with carboplatin (500 mg/m 2 / dose). The two groups were then compared in terms of 2- and 4-year overall survival (OS), event-free survival (EFS) and disease-free survival (DFS). Results. Two- and four-year OS rates in the carboplatin group were 90.0% and 90.0%, compared to 100.0% and 88.0%, respectively, in the non-carboplatin group. Two- and four-year EFS levels in the carboplatin group were 92.0% and 88.0%, respectively, compared to 82.0% and 76.0% in the non-carboplatin group. Two-and four-year DFS levels in the carboplatin group were 92.0% and 86.0%, respectively, compared to 77.0% and 77.0% in the non-carboplatin group. Conclusions. The findings show that the carboplatin can be used as an alternative drug in the primary treatment of WT in the event that actinomycin-D is unavailable or not tolerated. Pediatr Blood Cancer 2014;61:1578–1583. # 2014 Wiley Periodicals, Inc. Key words: actinomycin-D; carboplatin; Wilms tumor Cukurova University Medical School, Division of Pediatric Oncology and BMT Unit, Adana, Turkey Conflict of Interest: Nothing to declare.  Correspondence to: Can Acipayam, Hatay Antakya Government Hospital, Department of Pediatric Hematology and Oncology, 31040 Hatay, Turkey. E-mail: cacipayam@hotmail.com Received 18 October 2013; Accepted 10 March 2014  C 2014 Wiley Periodicals, Inc. DOI 10.1002/pbc.25047 Published online 11 April 2014 in Wiley Online Library (wileyonlinelibrary.com).