A 4-year-old child is found to have an abdominal mass. CT scan shows a large heterogeneous renal mass with areas of necrosis and calcification. The contralateral kidney is normal. Chest CT shows no metastases. This is stage I disease. The treatment regimen is:
- A Surgery alone (radical nephrectomy)
- B Radical nephrectomy followed by vincristine + actinomycin D (NWTS protocol) ✓
- C Pre-operative chemotherapy (vincristine + actinomycin D) followed by nephrectomy and adjuvant chemotherapy
- D Radiotherapy and systemic chemotherapy without surgery
Correct answer: B. Radical nephrectomy followed by vincristine + actinomycin D (NWTS protocol)
Explanation
Wilms tumor (nephroblastoma) stage I (tumor confined to kidney, completely resected) is managed by upfront nephrectomy (NWTS/Children's Oncology Group protocol) followed by adjuvant chemotherapy with vincristine + actinomycin D for 18 weeks. Pre-operative chemotherapy (SIOP protocol) is used in Europe and for selected cases (bilateral disease, large tumors, IVC/atrial thrombus). Stage I favorable histology has a >90% survival. Surgery alone is not appropriate as chemotherapy significantly reduces relapse.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.