A 2-year-old boy is found to have a right-sided abdominal mass. CT scan shows a large heterogeneous intrarenal mass with focal areas of calcification. No lymph node involvement or metastases. This is stage I. Which treatment approach is used in India per NWTS/COG protocol?

• A Pre-operative chemotherapy (vincristine + actinomycin D) followed by nephrectomy
• B Nephrectomy + retroperitoneal radiotherapy + chemotherapy for all stages
• C Immediate nephrectomy followed by adjuvant chemotherapy (vincristine + actinomycin D) with no radiotherapy for stage I favorable histology ✓
• D Biopsy only, followed by targeted therapy based on CTNNB1 mutation status

Explanation

Wilms tumor (nephroblastoma) stage I with favorable histology: per the COG/NWTS protocol (followed in most Indian centers), upfront nephrectomy (radical) is performed without preoperative chemotherapy, followed by adjuvant chemotherapy with vincristine + actinomycin-D for 18 weeks. Abdominal radiotherapy is NOT given for stage I or II favorable histology — this substantially reduces late side effects. The European (SIOP) protocol uses pre-operative chemotherapy first to downstage the tumor, but the COG protocol favors upfront surgery for resectable disease. Survival rates for stage I favorable histology exceed 95%.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.