Significant advances have been made in the treatment of children with Wilms' tumor. Whereas 50 years ago overall survival was less than 10%, current survival estimates approach 90%. This progress has been made possible by the cooperation of pediatric oncologists, surgeons, pathologists, radiation oncologists, and support personnel in their joint quest to find a cure for this intriguing childhood neoplasm. The next goals are to determine better treatment for patients with unfavorable histology tumors or recurrent disease and to identify patients who may not require adjuvant therapy. Also, the role of renal parenchymal-sparing resections needs to be defined further.