What treatment approach would you use for patients with localized Wilms tumor which is unilateral, favorable histology, negative LOH, who develop a new lung nodule at the end of therapy?

First, I would confirm whether the new lung nodule represents recurrent disease by biopsy or resection.

If positive for tumor, the treatment recommendation would depend on the initial therapy. For relapse after vincristine/dactinomycin (low-risk relapse), an accepted standard is "Regimen I" (vincris...