How do you determine whether to offer whole lung radiation to children with favorable histology Wilms, lung metastases, and a CR on chemo, without knowledge of 1p16q status, as per the AREN0533 protocol?

AREN0533 schema requires knowledge of 1p16q status, though this test is not available off-protocol. How does this affect management for patients treated per, but not on, protocol, such as a 2 yo male with favorable histology Wilms and unknown 1p16q status who p/w upfront sub-cm lung metastases and has had a CR at week 6?

Answer from: Radiation Oncologist at Academic Institution

With very small lung metastases to begin with , I would withhold whole lung radiation if a CR is achieved with chemotherapy.

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How do you determine whether to offer whole lung radiation to children with favorable histology Wilms, lung metastases, and a CR on chemo, without knowledge of 1p16q status, as per the AREN0533 protocol?

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