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
Condition: Stage I Kidney Wilms Tumor; Stage II Kidney Wilms Tumor; Stage III Kidney Wilms Tumor
MeSH terms: Neoplasms; Wilms Tumor
Intervention: 3-Dimensional Conformal Radiation Therapy; Dactinomycin; Doxorubicin Hydrochloride; Therapeutic Conventional Surgery; Vincristine Sulfate
Intervention description: Patients undergo radiotherapy; Given IV; Given IV; Undergo surgery; Given IV
Intervention MeSH terms: Dactinomycin; Cactinomycin; Doxorubicin; Liposomal doxorubicin; Vincristine
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 808.0
Sex: All
Maximum age: 29 Years
Healthy volunteers: No

Summary:

      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. Radiation therapy uses high-energy x-rays to kill tumor cells. 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.
    

Eligibility criteria:

        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