This protocol covers children younger than 2 years presenting with unilateral, resectable, stage I Wilms tumor of favorable histology and a tumor weight below 550 g — the population classified as the COG very-low-risk group.
Very-low-risk classification is based on the combination of young age (under 2 years), stage I disease, favorable histology, and tumor weight under 550 g. Children with favorable histology Wilms tumor meeting these criteria may be candidates for observation without adjuvant therapy following resection, or for adjuvant chemotherapy, as defined by COG criteria.
Management centres on surgical resection. For patients in this very-low-risk group who subsequently relapse, a more intensive multimodal approach — beyond initial adjuvant options — is employed. The complete protocol with full selection criteria and sequencing is available via the link below.
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.
The children who relapsed after surgery alone were successfully treated with more intensive therapy than EE4A (doxorubicin and RT).
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