Take a breather.

Kids with Wilms tumor and lung metastases have historically been treated with whole lung irradiation (WLI). In AREN0533, WLI was omitted in patients with both favorable histology and complete resolution of lung mets after 6 weeks of chemo. Patients with LOH 1p/16q (unfavorable) or an incomplete response went on to receive more intensive chemo and WLI. The results? There were more events (20%) than expected (15%) when omitting WLI for favorable patients, who had an EFS rate at 4 years of 79%. This is still pretty good, but not compared to the 89% EFS rate in those who warranted WLI. Overall survival at 4 years was comparable between groups at 95%. TBL: Omission of low-dose WLI in children with favorable Wilms resulted in a 10% detriment in EFS when compared to their counterparts with unfavorable and/or refractory disease receiving WLI. | Dix, J Clin Oncol 2018