An Update on Current Treatment Options for Pediatric Genitourinary Tract Tumors

Abstract

Most of the success and advances made in the care of children with genitourinary (GU) cancer over the last 50 years are thanks in large part to the efforts of the cooperative pediatric oncology groups both in North America and Europe. Currently, children with tumors of the kidney, bladder, prostate, and testis/para-testis largely enjoy a good prognosis thanks to the outstanding research into these relatively rare diseases. Evidence-based and protocol-driven care has resulted in outstanding rates of cure. The future of the care for these children with GU malignancy is to preserve these outcomes while minimizing the morbidity of therapy. One area of great interest across these entities is risk stratification which holds the potential to reduce the burden of therapy in those who can afford to do so and reserve more aggressive treatments for those with risk factors for poor prognosis. From a surgical standpoint, there is an increasing interest in reducing morbidity as well. For renal tumors, this includes nephron-sparing and minimally invasive surgery when possible. For bladder and prostate tumors, there is an increasing emphasis on organ preservation and non-exenterative surgery. Regardless of these surgical advances, the future of pediatric GU cancer therapy likely rests more in tumor-biology-driven risk stratification and personalized therapy. Thus, from a surgical standpoint, there is motivation for surgeons to think beyond just the surgery and to be involved and be knowledgeable about all of the multidisciplinary aspects of pediatric cancer care.