Vincristine, Dactinomycin, and Doxorubicin With or Without Radiation Therapy or Observation Only in Treating Younger Patients Who Are Undergoing Surgery for Newly Diagnosed Stage I, Stage II, or Stage III Wilms' Tumor

This phase III trial is studying vincristine, dactinomycin, and doxorubicin with or without radiation therapy or observation only to see how well they work in treating patients undergoing surgery for newly diagnosed stage I, stage II, or stage III Wilms' tumor. Drugs used in chemotherapy, such as vincristine, dactinomycin, and doxorubicin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high energy x-rays, particles, or radioactive seeds to kill cancer cells and shrink tumors.Giving these treatments after surgery may kill any tumor cells that remain after surgery. Sometimes, after surgery, the tumor may not need additional treatment until it progresses. In this case, observation may be sufficient.

Sex

All

Maximum age

29 Years

Inclusion Criteria:

* Histologically confirmed Wilms' tumor

  * Newly diagnosed stage I-III disease
  * Favorable histology
* No moderate- or high-risk Wilms' predisposition syndromes
* Must meet 1 of the following disease stratification categories:

  * Very low-risk disease

    * Stage I disease
    * Age \< 2 years
    * Tumor weight \< 550 g
    * Regional lymph nodes histologically negative (must have been sampled)
    * No pulmonary metastases on CT scan of chest
    * No synchronous bilateral Wilms tumors (Stage V)
    * Not predisposed to develop bilateral Wilms tumors, defined as unilateral Wilms tumor and any of the following:

      * Aniridia
      * Beckwith-Wiedemann syndrome
      * Simpson-Golabi-Behmel syndrome
      * Denys-Drash syndrome or other associated genito-urinary anomalies
      * Multicentric WT or unilateral WT with contralateral nephrogenic rest(s) in a child \< 1 year of age
      * Diffuse hyperplastic perilobar nephroblastomatosis
  * Standard-risk disease meeting 1 of the following criteria:

    * Disease does not require radiotherapy

      * LOH at chromosomes 1p and 16q for stage I or II
      * Stage I disease meeting 1 of the following criteria:

        * Age ≥ 2 years to age \< 30 years
        * Tumor weight ≥ 500 g
      * Stage II disease

        * Age \< 30 years
        * Any tumor weight
    * Disease requires radiotherapy

      * No LOH at chromosomes 1p and 16q\*
      * Stage III disease
* Must be enrolled on protocol COG-AREN03B2
* Karnofsky performance status (PS) 50-100% for patients \> 16 years old
* Lansky PS 50-100% for patients ≤ 16 years old
* Bilirubin (direct) ≤ 1.5 times upper limit of normal (ULN)
* AST or ALT \< 2.5 times ULN
* Shortening fraction ≥ 27% by echocardiogram OR ejection fraction ≥ 50% by radionuclide angiogram (standard-risk disease)
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patient must use effective contraception
* No prior tumor-directed chemotherapy or radiotherapy

  * Patients transferring from AREN03B2 with LOH 1p and 16q allowed

• DERIVEDDix DB, Fernandez CV, Chi YY, Mullen EA, Geller JI, Gratias EJ, Khanna G, Kalapurakal JA, Perlman EJ, Seibel NL, Ehrlich PF, Malogolowkin M, Anderson J, Gastier-Foster J, Shamberger RC, Kim Y, Grundy PE, Dome JS; AREN0532 and AREN0533 study committees. Augmentation of Therapy for Combined Loss of Heterozygosity 1p and 16q in Favorable Histology Wilms Tumor: A Children's Oncology Group AREN0532 and AREN0533 Study Report. J Clin Oncol. 2019 Oct 20;37(30):2769-2777. doi: 10.1200/JCO.18.01972. Epub 2019 Aug 26. PMID 31449468
• DERIVEDFernandez CV, Mullen EA, Chi YY, Ehrlich PF, Perlman EJ, Kalapurakal JA, Khanna G, Paulino AC, Hamilton TE, Gow KW, Tochner Z, Hoffer FA, Withycombe JS, Shamberger RC, Kim Y, Geller JI, Anderson JR, Grundy PE, Dome JS. Outcome and Prognostic Factors in Stage III Favorable-Histology Wilms Tumor: A Report From the Children's Oncology Group Study AREN0532. J Clin Oncol. 2018 Jan 20;36(3):254-261. doi: 10.1200/JCO.2017.73.7999. Epub 2017 Dec 6. PMID 29211618
• DERIVEDFernandez CV, Perlman EJ, Mullen EA, Chi YY, Hamilton TE, Gow KW, Ferrer FA, Barnhart DC, Ehrlich PF, Khanna G, Kalapurakal JA, Bocking T, Huff V, Tian J, Geller JI, Grundy PE, Anderson JR, Dome JS, Shamberger RC. Clinical Outcome and Biological Predictors of Relapse After Nephrectomy Only for Very Low-risk Wilms Tumor: A Report From Children's Oncology Group AREN0532. Ann Surg. 2017 Apr;265(4):835-840. doi: 10.1097/SLA.0000000000001716. PMID 27811504