A 3-year-old boy is found to have a right-sided Wilms' tumor (nephroblastoma) on ultrasound — a 9 cm lesion with intact capsule and no IVC involvement. According to COG (Children's Oncology Group) protocol, what is the correct management sequence?
- A Neoadjuvant chemotherapy followed by nephrectomy (European SIOP approach)
- B Bilateral nephrectomy followed by renal transplantation
- C Immediate upfront nephrectomy followed by adjuvant chemotherapy and possibly radiotherapy based on stage ✓
- D Radical nephrectomy followed by observation only for stage I tumors
Explanation
The North American COG protocol for Wilms' tumor recommends upfront nephrectomy (without prior biopsy or neoadjuvant chemotherapy) to provide accurate histological staging, which guides adjuvant chemotherapy. The European SIOP protocol uses neoadjuvant actinomycin D + vincristine chemotherapy first to shrink the tumor. Both approaches yield similar outcomes. COG defines stage I as tumor confined to kidney, completely resected — these receive only actinomycin D + vincristine without radiotherapy. Histology (favourable vs anaplastic) significantly influences regimen intensity.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.