Wilms Tumor in Children Younger Than 2 Years: Stage I, Favorable Histology, Very-Low-Risk (COG)

This protocol covers resectable, unilateral, favorable histology Wilms tumor in the specific sub-population classified by the Children's Oncology Group (COG) as very low risk — defined by a combination of patient age, tumor stage, and tumor weight.

Clinical Scenario

Children younger than 2 years with stage I, unilateral, favorable histology Wilms tumor and a tumor weight of less than 550 g. Together, these features qualify a child for the COG very-low-risk group, which has its own post-surgical management pathway distinct from higher-risk presentations.

Treatment Approach (partial)

Initial management centers on upfront surgical resection of the affected kidney with regional lymph node evaluation. Whether any additional treatment is given after surgery — and what form it takes — depends on findings at the molecular level assessed in the resected specimen.

The complete decision pathway, including all post-surgical options and the specific criteria that determine them, is in the full protocol.

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References

DOI: 10.6004/jnccn.2021.0037

These children were deemed at very low risk because they were younger than 2 years, their tumor weight was less than 550 g, and they had stage I disease.

Children with FHWT fitting the criteria of the COG very-low-risk group can be observed without adjuvant therapy or receive adjuvant chemotherapy with EE4A.

Observation only after surgery is recommended for children without unfavorable prognostic biomarkers. Postoperative RT is not recommended for stage I disease.

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