Recruiting
Phase 2

Proton Beam Irradiation

Sponsor:

St. Jude Children's Research Hospital

Code:

NCT04968990

Conditions

Wilms Tumor

Eligibility Criteria

Sex: All

Age: 0+

Healthy Volunteers: Not accepted

Interventions

Proton Beam Radiation (PBRT)

DD-4A Chemotherapy Regimen

Complete Surgical Resection

Surgical Resection

Partial Nephrectomy

Study Details

Brief summary:

Participants are being asked to take part in this clinical trial, a type of research study, because the participants have a Wilms Tumor cancer.

Primary Objectives

To determine whether delivery of proton beam radiation to a conformal reduced target volume in the flank allows normal flank growth compared to the contralateral untreated side and non-irradiated patients.

Secondary Objectives

To deliver proton beam radiation to a conformal reduced target volume (partial kidney proton beam radiation therapy) in the affected kidney(s) for patients with Stage V (bilateral Wilms tumor) and specific involved surgical margins yielding no reduction in the high control rates seen with more traditional flank / whole kidney fields.

Exploratory Objectives

  • Study the feasibility of sparing the residual kidney, spine and liver in patients requiring whole abdomen radiation therapy using either a proton beam treatment technique or intensity-modulated radiation therapy ( IMRT) photon based technique.
  • Study the feasibility of delivering whole lung radiation therapy with proton beams with the goals of sparing the developing breast tissue, heart structures, thyroid and liver.
  • Develop simultaneous xenografts and organoid models from the same starting material to study Wilms tumor biology and compare responses to chemotherapeutic agents.
  • Define the evolution of organ specific (kidney, liver, pancreas, etc.) abnormalities (laboratory studies) as an early marker of possible late end organ damage and their relationship to radiation.
  • Study and evaluate impact of proton therapy on the musculoskeletal system and physical performance and compare with photon therapy cases treated with classical treatment fields.
  • Assess CTC-AE and Pediatric Patient Reported Outcomes during radiation and in follow-up, correlating with disease, treatment and patient variables.
  • Correlate quantitative MRI values, including apparent diffusion coefficient (ADC) values, with histopathology findings post-surgery in children with (bilateral) Wilms.
  • Assess daily variations in proton range along each treatment beam using standard pre-treatment cone beam CT or on-treatment MR.

Conditions

Wilms Tumor

Study ID

NCT04968990

Start date

Aug 19, 2021

Status verified date

Apr, 2026

Completion date

Dec, 2036

Anticipated

Primary completion date

Dec, 2026

Anticipated

Eligibility Criteria

Eligibility Criteria

Sex: All

Age: 0+

Healthy Volunteers: Not accepted

Inclusion Criteria:

  • Patients are eligible to be enrolled on this trial at the time of initial (or presumptive) diagnosis of Wilms tumor, at the time of surgery or at the time of radiation treatment.
  • Patients that are determined to be stage I or II will be eligible for the surgical and biologic aspects of this trial but will otherwise be followed per institutional standards and be "off therapy" at the time of stage determination (followed only for survival).
  • Patients identified to have an anaplastic or other unfavorable tissue component (non-Wilms histology) to their tumor may have tissue assessed for the biology objective but will be removed from the therapeutic portion of the study at the time of identification of this pathologic finding.

Performance Level • The Karnofsky performance status must be ≥50 for patients >16 years of age and the Lansky performance status must be ≥ 50 for patients ≤ 16 years of age.

Prior Therapy

  • Only prior therapy with the initial chemotherapy regimen defined in section 5.1 and Appendix III are allowed for patients that are treated with neoadjuvant chemotherapy. These patients may change to an alternate regime based on response or biologic features and noted in section 5.1. Prior biopsy or surgery is allowed.
  • Prior radiation therapy is not allowed if directed at the abdomen. Emergent RT to other sites of disease is acceptable.

Organ Function Requirements:

  • None - As per institutional standard of care. Diagnosis / Stage
  • Presumed diagnosis of Wilms tumor (continued management on trial will depend on stage and histology)
  • Resected upfront stage III, IV or V favorable histology Wilms tumor. Stage III includes any one or multiples of the following:

  • Lymph nodes within the abdomen or pelvis are involved by tumor. (Lymph node involvement in the thorax, or other extra-abdominal sites is a criterion for Stage IV)
  • The tumor has penetrated through the peritoneal surface
  • Tumor implants are found on the peritoneal surface
  • Gross or microscopic tumor remains post-operatively (e.g., tumor cells are found at the margin of surgical resection on microscopic examination - in the post chemotherapy setting only specific types of viable tumor at the surgical margin are considered stage III AND require adjuvant radiation - see surgery / pathology / radiation section for additional details)
  • The tumor is not completely resectable because of local infiltration into vital structures
  • Tumor spillage occurring either before or during surgery
  • A trans abdominal biopsy (regardless of type- tru-cut, open or fine needle aspiration) was performed prior to resection or chemotherapy. Retroperitoneal biopsies DO NOT require radiotherapeutic management like stage III
  • Tumor is removed in greater than one piece (e.g. tumor cells are found in a separately excised adrenal gland; a tumor thrombus within the renal vein is removed separately from the nephrectomy specimen). Extension of the primary tumor within vena cava into thoracic vena cava and heart is considered Stage III, rather than Stage IV even though outside the abdomen.
  • Stage IV - Hematogenous metastases (lung, liver, bone, brain, etc.), or lymph node metastases outside the abdomino-pelvic region are present. (The presence of tumor within the adrenal gland is not interpreted as metastasis and staging depends on all other staging parameters present). Patients with lung involvement and local abdominal stage I or II are eligible to remain on trial for whole lung irradiation objective.
  • Stage V - Bilateral renal involvement by tumor is present at diagnosis. An attempt should be made to stage each side according to the above criteria on the basis of the extent of disease
  • Patients that have or will receive neoadjuvant chemotherapy for unresected unilateral or bilateral Wilms tumor without a biopsy are not assumed to be require adjuvant radiation on this study. That determination will be based on surgical findings and the approach to treatment detailed in the protocol.

Timing

  • Patients undergoing upfront surgery must start RT, if indicated, within 28 days of definitive surgery with a goal of starting RT by day 21.
  • Patients receiving neoadjuvant chemotherapy will be enrolled either at diagnosis (if at St. Jude) or at the time of RT.

Other Criteria

• Female patients of childbearing potential (age ≥10 years old or post-menarche) must have a negative pregnancy test prior to enrollment.

Exclusion Criteria:

  • Inability or unwillingness to provide written informed consent
  • Prior radiation therapy to a site to be treated with proton / photon radiation as part of this trial. Emergent radiation is allowed.

Study Design

Enrollment

260 participants

Anticipated

Allocation

Non randomized

Intervention Model

Single group

Primary purpose

Treatment

Interventions and Outcome Measures

Arms

active comparator: Favorable Histology Stage I & II and FH Stage III/IV

Favorable Histology Stage I \& II and FH Stage III/IV Delayed Local Control with clear surgical margins and pathologically negative lymph nodes. Participants will undergo complete surgical resection at diagnosis or after 6-12 weeks of induction chemotherapy.

active comparator: Stage III & IV Adjuvant RT and Stage V

Participants will undergo surgical resection at diagnosis or after 6-12 weeks of induction chemotherapy. Those with evidence of LN involvement, surgical margin involvement, local or diffuse spill, gross disease in the renal bed or peritoneal implants, will receive adjuvant PBRT.

active comparator: Stage V Adjuvant RT:

Participants will undergo partial nephrectomy after 6-12 weeks of induction chemotherapy. Those with evidence of LN involvement, surgical margin involvement, local or diffuse spill, gross disease in the renal bed or peritoneal implants, will receive adjuvant PBRT

Interventions

Proton Beam Radiation (PBRT)

The treatment approach with radiation therapy prescribed in this trial is designed to deliver highly conformal radiation therapy (proton beam radiation or intensity modulated photon radiation) to target volumes that are based on the burden of disease.

DD-4A Chemotherapy Regimen

Patients will receive standard of care chemotherapy based on diagnosis and stage.

Complete Surgical Resection

Participants will undergo complete surgical resection at diagnosis or after 6-12 weeks of induction chemotherapy

Surgical Resection

Participants will undergo surgical resection at diagnosis or after 6-12 weeks of induction chemotherapy.

Partial Nephrectomy

Participants will undergo partial nephrectomy after 6-12 weeks of induction chemotherapy.

Primary outcome measure

  • Half circumference at 3 year [ Time Frame: 3 years after all patients finish proton therapy ]
  • Half circumference at 5 year [ Time Frame: 5 years after all patients finish proton therapy ]
  • Half circumference at 7 year [ Time Frame: 7 years after all patients finish proton therapy ]
  • Half circumference at 10 year [ Time Frame: Half circumference measurement at 10 year from irradiated and unirradiated hemi-abdomen ]

Central Contacts and Locations

Central contacts

Matthew J Krasin, MD

888-226-4343referralinfo@stjude.org

Locations

St.Jude Children's Research Hospital

Recruiting

Memphis, Tennessee, United States, 38105

Contacts

Matthew J Krasin, MD

888-226-4343referralinfo@stjude.org

Principal Investigator:

Matthew J Krasin, MD

More Information

Sponsor

St. Jude Children's Research Hospital

Last update posted

Apr 23, 2026

Last verified

Apr, 2026

Keywords

  • Retroperitoneum
  • Retroperitoneal subsites
  • Kidney
  • Lymph node involvement
  • Abdomen

Trial information was received from ClinicalTrials.gov and was last updated on 2026-09-09. This information was provided to ClinicalTrials.gov by St. Jude Children's Research Hospital on 2026-04-23.