A commentary notes this study is valuable because the findings suggest that doxorubicin might not be needed for the treatment of a substantial new subgroup of children with Wilms’ tumour. However, it cautions that this is dependent upon the accurate diagnosis of intermediate-risk histology, and the risk of generalising these results to children with stage II–III, histological intermediate-risk is that some will still be high risk after central pathological review, and will be undertreated if chemotherapy with only two drugs is continued. The commentator adds that the more important limitation of these findings is that they apply only to children who receive prenephrectomy chemotherapy with vincristine and actinomycin D- many children in North America and elsewhere routinely undergo immediate nephrectomy for a suspected Wilms’ tumour. Nevertheless, he commends the researchers for taking a risk in their study and showing that, within the restrictions of their statistical design, omission of a chemotherapeuticagent that would produce cardiac injury, albeit subclinical in the short term, did not result in an inferior outcome in most patients who were treated.