Daw NC, Chi YY, Kim Y, et al. - Given that the fifth National Wilms Tumor Study (NWTS-5) of 29 patients with stage I focal (n = 10) or diffuse (n = 19) anaplastic Wilms' tumor (AWT), which were treated with vincristine and dactinomycin without flank radiation, had the 4-year event-free survival (EFS) and overall survival (OS) estimates of 69.5% and 82.6%, respectively. In the Children's Oncology Group AREN0321 study, survival for these patients was evaluated when doxorubicin and flank radiation are added. Enrollment of 18 patients with stage I AWT (8 focal and 10 diffuse) on AREN0321 was done. Outcomes revealed excellent survival outcomes following treatment of stage I AWT with vincristine, dactinomycin, doxorubicin and flank radiation in AREN0321. As per retrospective analysis of AREN0321 and NWTS patients, doxorubicin vs radiation had a greater contribution to the excellent outcomes.