This protocol covers the post-surgical management of children with stage I or II favorable histology Wilms tumor (FHWT) who are classified as low risk following surgical resection.
Children with stage I or II favorable histology Wilms tumor at low risk after surgery represent a specific sub-population in which adjuvant therapy planning is guided by surgical stage, histology classification, and tumor biomarker status at the time of nephrectomy.
Adjuvant chemotherapy following upfront nephrectomy is the primary post-surgical intervention for eligible children in this low-risk group. Postoperative radiation therapy is not recommended for local stage I and II disease.
The specific chemotherapy regimen — and the conditions under which it is continued or modified based on tumor biomarker findings — are detailed in the full structured protocol.
DOI: 10.6004/jnccn.2021.0037
Children with FHWT at low risk after surgery can receive adjuvant therapy with regimen EE4A or switch to regimen DD4A.
When treated with adjuvant EE4A, children with stage I or II FHWT with combined LOH at 1p and 16q had a 4-year relapse-free survival of 74.9% versus 91.2% for those without these markers.
EE4A can be continued for children with tumors that do not have these unfavorable biomarkers.
Postoperative RT is not recommended for local stage I and II disease.
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