Children presenting with metastatic bilateral favorable-histology Wilms tumor represent a distinct clinical scenario. Bilateral involvement and metastatic extent require a carefully coordinated approach that prioritizes both tumor control and preservation of renal function.
This protocol applies to children with metastatic bilateral renal tumors (favorable histology Wilms tumor), with or without a predisposing condition. The bilateral nature of the disease is a defining factor that shapes both the systemic and surgical strategy.
The primary objectives are complete tumor response and achieving resectability of bilateral tumors, assessed at a defined interval following the initiation of systemic therapy. Nephron-sparing surgery — preserving as much renal function as possible — is a central surgical goal.
The recommended approach begins with neoadjuvant combination chemotherapy using the VAD regimen, delivered before any surgical intervention. Tumor response is formally reassessed at six weeks to determine whether and when nephron-sparing surgery can proceed.
DOI: 10.6004/jnccn.2021.0037