Treatment for Very Low-Risk and Standard-Risk Favorable Histology Wilms Tumor

Surgery, chemotherapy, and/or radiation therapy are routinely used to treat Wilms tumor (a kidney cancer that most commonly occurs in children). In this Children’s Oncology Group study, researchers are determining the best way to treat patients with different types of very low-risk and standard-risk Wilms tumor which had a favorable histology at the time of diagnosis.

Three different treatment approaches are being evaluated in this study:

• For patients with stage I/II disease with genetic changes that indicate their risk of recurrence is elevated, investigators want to see if adding the drug doxorubicin to vincristine and dactinomycin, given after cancer surgery, improves outcome.
• For patients under age 2 with a small stage I Wilms tumor, doctors want to see if these patients can be treated with surgery alone followed by careful observation, which would spare them from the side effects of chemotherapy.
• For patients who were treated with surgery only on this protocol and the tumor has returned, researchers are assessing additional surgery plus chemotherapy (vincristine, dactinomycin, doxorubicin) and radiation therapy if the recurrent cancer has not affected the remaining kidney; for those with cancer returning in the remaining kidney, patients will receive the same three chemotherapy drugs to shrink the tumor, followed by surgery to remove any remaining cancer.

Researchers are also seeking new molecular markers that may predict how well a patient responds to a certain type of therapy.