Children with a unilateral renal tumor — favorable histology Wilms tumor — that was initially unresectable, with no underlying genetic predisposition condition. This protocol applies once the initial chemotherapy approach has been attempted and the defined resectability goal has not been met.
The standard first step is an upfront biopsy to confirm diagnosis and obtain molecular biomarkers, followed by neoadjuvant therapy with DD4A. The critical checkpoint is week 6: the tumor must become resectable. If imaging at week 6 shows an inadequate response — the tumor has not become resectable — this protocol defines the next clinical step.
For patients who do not meet the week 6 resectability target, an augmented multi-agent chemotherapy regimen given over 24 weeks is indicated. In select patients, radiation therapy to specific anatomic sites is incorporated based on disease extent, metastatic pattern, and tumor biology. The complete regimen, agent selection, sequencing, and full radiation criteria are contained in the structured protocol.
DOI: 10.6004/jnccn.2021.0037