{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T18:44:06Z","timestamp":1790275446315,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The AHOPCA (Asociaci\u00f3n de Hemato\u2010Oncolog\u00eda Pedi\u00e1trica de Centro Am\u00e9rica) Wilms tumor (WT) treatment guidelines, adapted from NWTS\u20104 and \u20105 and recommending upfront nephrectomy (UN), were modified to include 4\u20136 weeks of preoperative chemotherapy (POC) in frail patients with advanced disease. We aim to describe the outcomes of this implemented approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedure<\/jats:title>\n                    <jats:p>A retrospective analysis of prospectively collected data from newly diagnosed patients with unilateral WT between 2012 and 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 353 eligible patients, 247 (70%) received POC. The POC group had higher initial tumor volume (median 590\u00a0mL vs. 308\u00a0mL,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001) and more Stage IV disease (30%\u00a0vs. 3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.0001) compared to the UN group. During POC, there were 4 deaths, 14 abandonments, and 11 progressive diseases. After response assessment, 62% showed partial tumor response with a median tumor volume reduction to 257\u00a0mL. A total of 218 (88.2%) patients underwent nephrectomy. Tumor rupture\/spillage occurred in 17.9% of the UN and 18.8% of the POC group; local Stage III was found in 55% of the UN and 68.3% of the POC group. Anaplasia (focal and diffuse) was present in 13.6% (17% UN and 11.9% POC). The 5\u2010year abandonment\u2010sensitive event\u2010free survival (asEFS) and abandonment\u2010sensitive overall survival (asOS) rates were 69%\u00a0\u00b1\u00a02.5% and 75%\u00a0\u00b1\u00a02.4%, respectively. The asEFS rates were 75%\u00a0\u00b1\u00a04.3% for UN and 66%\u00a0\u00b1\u00a03.0% for POC (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.07).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Many AHOPCA patients presented with unresectable advanced disease, requiring the use of POC. POC effectively reduced tumor volume and facilitated safe surgery in fragile patients. Adopting the standard SIOP WT neoadjuvant approach could enhance staging and risk stratification in AHOPCA.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.32148","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T05:50:17Z","timestamp":1762494617000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Second Generation of AHOPCA (Asociaci\u00f3n de Hemato\u2010Oncolog\u00eda Pedi\u00e1trica de Centro Am\u00e9rica) Treatment Guidelines for Wilms Tumor: A Report of Outcomes"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8626-6244","authenticated-orcid":false,"given":"Thelma","family":"Velasquez\u2010Herrera","sequence":"first","affiliation":[{"name":"Unidad Nacional de Oncolog\u00eda Pedi\u00e1trica  Guatemala City 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