Deep learning segmentation models for pediatric oncology are often trained on small, single-center cohorts, whereas much larger datasets exist for adult diseases, such as kidney cancer. Whether models trained on adult renal lesions generalize to pediatric Wilms tumors remains unclear. We trained a segmentation model on single-sequence T1- or T2-weighted adult kidney MRI and evaluated it on a held-out adult test set and a pediatric Wilms tumor cohort, where it was compared with a pediatric-specific nnU-Net. Segmentation performance was quantified using the Dice similarity coefficient (DSC) and 95th-percentile Hausdorff distance. On the adult test set, the model achieved a median DSC of 0.86 for renal lesions. On the pediatric cohort, the adult-trained model achieved a median DSC of 0.85 compared with 0.90 for the pediatric-specific model. Despite differences in age, anatomy, and tumor type, the adult-trained model showed promising performance on pediatric Wilms tumors, with only a modest difference in median DSC compared with the pediatric-specific model. However, non-inferiority could not be shown, highlighting the value of pediatric training data. In future work, a fine-tuning strategy could be explored.

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