# Favorable Histology Wilms Tumor — GCMD Library living collection

Everything in the library about favorable histology Wilms tumor — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 32 cited statements

## Episodes
### Evidence & Research
- [Impact of Pulmonary Tumor Burden in Favorable Histology Wilms Tumor Outcomes: A Report From the Children's Oncology Group Study AREN053](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658) — video · 1:15 · [machine version](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658.md)
- [Updated Favorable histology Wilms tumor risk stratification: Rationale for future Children’s Oncology Group clinical trials](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856) — video · 0:53 · [machine version](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856.md)

### Case-Based Learning
- [Clinical & Research Update: Renal Tumors with Drs. Ethan Smith, Lindsay Haacker, Michael Daugherty, and Meera Kotagal](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740) — video · 1:11:52 · [machine version](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=0) Prognostic Factors in Favorable Histology Wilms Tumor with Lung Metastases (Ep 1)
- [0:00](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=0) Updated Wilms Tumor Risk Stratification (Ep 2)
- [3:39](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=219) Case 1: 15-month-old with large left renal mass — upfront nephrectomy decision (Ep 3)
- [10:40](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=640) Enhanced recovery after surgery (ERAS) protocol for abdominal tumors (Ep 3)
- [20:46](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1246) Case 2: 4-year-old with bilateral Wilms tumor — nephron-sparing approach (Ep 3)
- [36:30](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2190) Surgical technique for bilateral disease: incision choice, fluorescence guidance, leak prevention (Ep 3)
- [44:34](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2674) Case 3: 13-year-old with incidental renal lesion pre-BMT — robotic partial nephrectomy (Ep 3)
- [51:15](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3075) Case 4: 22-year-old with RCC and bone metastases — SDH-deficient subtype (Ep 3)
- [59:55](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3595) Case 5: 3-year-old with Wilms tumor and IVC thrombus — thrombectomy in continuity (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Tumors larger than 12 centimeters have an increased risk of intraoperative spill. — Meera Kotagal (clinical) [Ep 3 · 8:27](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=507)
- Biopsy can upstage the patient and change treatment down the line, including radiation that may otherwise not have been necessary. — Lindsay Haacker (clinical) [Ep 3 · 7:31](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=451)
- At least one lymph node must be sampled to be eligible for the current COG trial (AREN 2231). — Meera Kotagal (guideline) [Ep 3 · 10:18](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=618)
- The lymph node stations important for Wilms tumor include left renal hilar, periaortic, and aortic cable window. — Meera Kotagal (clinical) [Ep 3 · 9:55](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=595)
- AREN 2231 expands very low risk criteria to include any child less than 4 years old and eliminates the tumor weight threshold. — Lindsay Haacker (guideline) [Ep 3 · 16:12](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=972)
- Patients with one copy number gain (1q gain) are considered to have adverse biology on AREN 2231 and require chemotherapy. — Lindsay Haacker (guideline) [Ep 3 · 17:50](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1070)
- 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 Kotagal (clinical) [Ep 3 · 12:22](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=742)
- Length of stay with ERAS protocol is 3 to 4 days shorter than historical practice. — Meera Kotagal (epidemiological) [Ep 3 · 13:20](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=800)
- NG tube placement post-operatively is rare with ERAS; only one or two patients required it over 4-5 years. — Meera Kotagal (epidemiological) [Ep 3 · 13:40](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=820)
- Standard neoadjuvant chemotherapy for bilateral renal tumors is vincristine, dactinomycin, and doxorubicin (3-drug induction). — Lindsay Haacker (guideline) [Ep 3 · 26:19](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1579)
- Patients with bilateral disease need definitive surgery by week 12 because no ongoing tumor shrinkage is expected from chemotherapy alone beyond that point. — Lindsay Haacker (clinical) [Ep 3 · 27:21](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1641)
- In bilateral Wilms tumor, each side gets its own local stage, which impacts long-term management. — Meera Kotagal (clinical) [Ep 3 · 31:39](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1899)
- Preoperative ureteral stenting is done for all partial nephrectomies to optimize drainage and reduce urine leak risk, which can delay chemotherapy. — Michael Daugherty (clinical) [Ep 3 · 29:50](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1790)
- Partial nephrectomy for Wilms tumor often requires entering the collecting system because tumors sit deeper than typical RCC. — Michael Daugherty (clinical) [Ep 3 · 30:23](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1823)
- Cold (sharp) dissection without cautery around the renal pelvis and calyces reduces post-operative urine leak risk. — Michael Daugherty (clinical) [Ep 3 · 36:48](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2208)
- Partial nephrectomy is performed without vascular clamping; kidney compression provides adequate hemostasis and avoids ischemia. — Michael Daugherty (clinical) [Ep 3 · 37:25](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2245)
- Foley catheter is left in place for 3 to 4 days post-partial nephrectomy to allow mucosal healing. — Michael Daugherty (clinical) [Ep 3 · 39:22](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2362)
- Drains are not routinely used after partial nephrectomy; active suction can induce urine leak. — Michael Daugherty (clinical) [Ep 3 · 39:07](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2347)
- Focal anaplasia must be a clearly defined focus within the renal parenchyma, not in vascular spaces, with only one or two foci and none greater than 15 millimeters. — Lindsay Haacker (clinical) [Ep 3 · 32:48](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1968)
- 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 (guideline) [Ep 3 · 41:29](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2489)
- Renal transplant candidacy requires a two-year cancer-free interval. — Lindsay Haacker (guideline) [Ep 3 · 43:52](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=2632)
- Imaging is not sensitive or specific for lymph node involvement when nodes are in the intermediate size range. — Ethan Smith (clinical) [Ep 3 · 19:16](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=1156)
- TFE3-rearranged RCC shows widely disproportionate metastatic lymph nodes compared to primary tumor size; lymph nodes can be bigger than the tumor itself. — Ethan Smith (clinical) [Ep 3 · 56:01](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3361)
- In TFE3 RCC, node-positive patients who undergo resection may still be considered cured or have active disease treated. — Michael Daugherty (clinical) [Ep 3 · 56:55](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3415)
- RCCs are resistant to conventional chemotherapy; backbone of therapy is immune checkpoint inhibition, often combined with VEGF TKI. — Lindsay Haacker (clinical) [Ep 3 · 58:45](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3525)
- Pembrolizumab and axitinib (based on Keynote 426 study) showed superiority over sunitinib for RCC. — Lindsay Haacker (epidemiological) [Ep 3 · 58:55](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3535)
- Surgery is a mainstay of management for TFE RCC and provides meaningful survival benefit even in metastatic disease. — Meera Kotagal (clinical) [Ep 3 · 55:20](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=3320)
- Patients with slow pulmonary response (persistent nodules at week 6) require intensification to regimen M (cyclophosphamide and etoposide added to vincristine, dactinomycin, doxorubicin) due to worse outcomes without intensification. — Lindsay Haacker (guideline) [Ep 3 · 68:57](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=4137)
- IVC thrombus below the level of the hepatic veins should be resected upfront; intrahepatic extension warrants neoadjuvant chemotherapy. — Meera Kotagal (clinical) [Ep 3 · 66:58](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=4018)
- Thrombectomy must be performed in continuity with the nephrectomy specimen; transecting the thrombus upstages the patient to stage 3. — Meera Kotagal (clinical) [Ep 3 · 67:14](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=4034)
- Tumor thrombus is more adherent to the vessel wall after chemotherapy than in upfront resection. — Meera Kotagal (clinical) [Ep 3 · 70:01](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=4201)
- For IVC thrombus extending above the diaphragm, a thoracoabdominal approach with cardiac surgery support and potential bypass is used. — Meera Kotagal (clinical) [Ep 3 · 70:55](https://origin-library.globalcastmd.com/watch/clinical-research-update-renal-tumors-with-drs-ethan-smith-lindsay-haacker-micha-14740?t=4255)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Dick et al. published a report from a Children's Oncology Group study in the Journal of Clinical Oncology in 2025 — Jill Knepprath summarizing a resource [Ep 1 · 0:14](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=14)
- The study examined factors in patients with favorable histology Wilms tumor and pulmonary metastases and how those factors may affect outcomes — Jill Knepprath summarizing a resource [Ep 1 · 0:19](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=19)
- Factors studied included the number of metastases, the size of the metastases, and different biological markers — Jill Knepprath summarizing a resource [Ep 1 · 0:30](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=30)
- There was no difference in survival based on the number of metastases — Jill Knepprath summarizing a resource [Ep 1 · 0:36](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=36)
- Patients who had a rapid response to chemotherapy with larger nodules showed worse event-free survival — Jill Knepprath summarizing a resource [Ep 1 · 0:41](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=41)
- Patients with larger nodules and rapid response to chemotherapy showed no changes in overall survival — Jill Knepprath summarizing a resource [Ep 1 · 0:41](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=41)
- In multivariable models, neither the size nor the number of nodules had any effect on survival — Jill Knepprath summarizing a resource [Ep 1 · 0:49](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=49)
- 1q gain was associated with worse event-free survival — Jill Knepprath summarizing a resource [Ep 1 · 0:55](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=55)
- 1q gain was associated with worse overall survival — Jill Knepprath summarizing a resource [Ep 1 · 0:55](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=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 — Jill Knepprath summarizing a resource [Ep 1 · 1:04](https://origin-library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-r-11658?t=64)
- Risk stratification for Wilms tumor has evolved many times over the years. — Jill Knepprath summarizing a resource [Ep 2 · 0:00](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=0)
- The Children's Oncology Group published updated risk stratification for patients with favorable histology Wilms tumor in Nature in June 2025. — Jill Knepprath summarizing a resource [Ep 2 · 0:09](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=9)
- The new risk stratification model includes biological and clinical features that were not in the first generation risk stratification. — Jill Knepprath summarizing a resource [Ep 2 · 0:19](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=19)
- The new model changes some of the older features or gets rid of them altogether. — Jill Knepprath summarizing a resource [Ep 2 · 0:27](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=27)
- Factors being added are loss of heterozygosity of 11P15, 1Q gain, and lymph node involvement. — Jill Knepprath summarizing a resource [Ep 2 · 0:32](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=32)
- Tumor nephrectomy weight is no longer included in the risk stratification. — Jill Knepprath summarizing a resource [Ep 2 · 0:41](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=41)
- The model modified how histology and age are used to stratify certain patients. — Jill Knepprath summarizing a resource [Ep 2 · 0:43](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=43)
- More changes are expected in the future as ongoing COG trials produce more results. — Jill Knepprath summarizing a resource [Ep 2 · 0:48](https://origin-library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-11856?t=48)

## Changelog
- Oct 1: 3 items added automatically

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