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Favorable Histology Wilms Tumor

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episodes total cited expert statements Updated Nov 6, 2026
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Impact of Pulmonary Tumor Burden in Favorable Histology Wilms Tumor Outcomes: A Report From the Children's Oncology Group Study AREN053
David B Dix Geetika Khanna, Lindsay A Renfro, Ian C Tfirn, Ethan A Smith, Maddy Artunduaga, Meryle J Eklund, Jesse K Sandberg, Lauren N Parsons, John A Kalapurakal, Peter F Ehrlich, Jennifer H Aldrink, Richard D Glick, Daniel J Benedetti, C
video1:15 · Mar 2026
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Updated Favorable histology Wilms tumor risk stratification: Rationale for future Children’s Oncology Group clinical trials
Daniel J Benedetti, Nicholas G Cost, Peter F Ehrlich, Nicholas Evageliou, Elizabeth Fialkowski, Lauren N Parsons, Kelly L Vallance, Lindsay A Renfro, Andrew L Hong, Jennifer H Aldrink, Luke Pater, Arnold C Paulino, Jesse K Sandberg, Ethan A
video0:53 · Apr 2026
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Bilateral focal anaplasia Wilms tumor (stage 5, local stage 2 and 1) is treated with bilateral flank radiation and regimen DD4A (vincristine, dactinomycin, doxorubicin over 24-25 weeks). — Lindsay Haacker, Clinical & Research Update: Renal Tumors with Drs. Ethan Smith, Lindsay Haacker, Michael Daugherty, and Meera Kotagal · 41:29

Clinical & Research Update: Renal Tumors with Drs. Ethan Smith, Lindsay Haacker, Michael Daugherty, and Meera Kotagal
This video features a multidisciplinary panel from Cincinnati Children's, Drs. Ethan Smith, Lindsay Haacker, Michael Daugherty, & Meera Kotagal, discussing pediatric renal tumors, primarily Wilms tumor. Led by a pediatric oncology fellow, t
video1:11:52 · Sep 2026
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Impact of Pulmonary Tumor Burden in Favorable Histology Wilms Tumor Outcomes: A Report From the Children's Oncology Group Study AREN053
Dick et al. published a report from a Children's Oncology Group study in the Journal of Clinical Oncology in 2025
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:14
The study examined factors in patients with favorable histology Wilms tumor and pulmonary metastases and how those factors may affect outcomes
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:19
Factors studied included the number of metastases, the size of the metastases, and different biological markers
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:30
There was no difference in survival based on the number of metastases
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:36
Patients who had a rapid response to chemotherapy with larger nodules showed worse event-free survival
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:41
Patients with larger nodules and rapid response to chemotherapy showed no changes in overall survival
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:41
In multivariable models, neither the size nor the number of nodules had any effect on survival
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:49
1q gain was associated with worse event-free survival
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:55
1q gain was associated with worse overall survival
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:55
1q gain is the superior prognostic factor when compared to size and number of nodules in patients with favorable histology Wilms tumor and pulmonary metastases
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position1:04
Updated Favorable histology Wilms tumor risk stratification: Rationale for future Children’s Oncology Group clinical trials
Risk stratification for Wilms tumor has evolved many times over the years.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:00
The Children's Oncology Group published updated risk stratification for patients with favorable histology Wilms tumor in Nature in June 2025.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:09
The new risk stratification model includes biological and clinical features that were not in the first generation risk stratification.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:19
The new model changes some of the older features or gets rid of them altogether.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:27
Factors being added are loss of heterozygosity of 11P15, 1Q gain, and lymph node involvement.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:32
Tumor nephrectomy weight is no longer included in the risk stratification.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:41
The model modified how histology and age are used to stratify certain patients.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:43
More changes are expected in the future as ongoing COG trials produce more results.
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:48
Clinical & Research Update: Renal Tumors with Drs. Ethan Smith, Lindsay Haacker, Michael Daugherty, and Meera Kotagal
Tumors larger than 12 centimeters have an increased risk of intraoperative spill.
Meera Kotagal8:27
Biopsy can upstage the patient and change treatment down the line, including radiation that may otherwise not have been necessary.
Lindsay Haacker7:31
At least one lymph node must be sampled to be eligible for the current COG trial (AREN 2231).
Cites a guidelineMeera Kotagal10:18
The lymph node stations important for Wilms tumor include left renal hilar, periaortic, and aortic cable window.
Meera Kotagal9:55
AREN 2231 expands very low risk criteria to include any child less than 4 years old and eliminates the tumor weight threshold.
Cites a guidelineLindsay Haacker16:12
Patients with one copy number gain (1q gain) are considered to have adverse biology on AREN 2231 and require chemotherapy.
Cites a guidelineLindsay Haacker17:50
Enhanced recovery protocol includes preoperative carbohydrate load, regional anesthesia, no drains, early feeding (clears on post-op day 0, regular diet on post-op day 1), and IV fluids off on post-op day 1.
Meera Kotagal12:22
Length of stay with ERAS protocol is 3 to 4 days shorter than historical practice.
Meera Kotagal13:20
NG tube placement post-operatively is rare with ERAS; only one or two patients required it over 4-5 years.
Meera Kotagal13:40
Standard neoadjuvant chemotherapy for bilateral renal tumors is vincristine, dactinomycin, and doxorubicin (3-drug induction).
Cites a guidelineLindsay Haacker26:19
Patients with bilateral disease need definitive surgery by week 12 because no ongoing tumor shrinkage is expected from chemotherapy alone beyond that point.
Lindsay Haacker27:21
In bilateral Wilms tumor, each side gets its own local stage, which impacts long-term management.
Meera Kotagal31:39
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