Onco pediatric

A three-year-old boy has a 12 cm solid left renal mass with a normal

right kidney. During left nephrectomy, the tumor capsule is ruptured
with minimal tumor spillage, but there is a complete resection.
Pathology is favorable histology WiIms' tumor with negative lymph
nodes. The next step is:

A. XRT.
B. dactinomycin, vincristine, and doxoru bicin.
C. dactinomycin, vincristine, and XRT.
D. dactinomycin, vincristine, doxorubicin, and XRT.
En cyclophosphamide, vincristine, doxorubicin, and etoposide

ANSWER=D

Any tumor spillage increases the tumor stage to at least stage 3.

National Wilms' Tumor Study - 3 (NWTS-3) demonstrated that

for

favorable-histology disease stage 3, >>>

10.8 Gy of abdominal irradiation was as effective as 20 Gy in

preventing abdominal relapse if doxorubicin was added t o
vincristine and dactinomycin.

Unfavorable histology with diffuse anaplasia would require

additional agents including cyclophosphamide and etoposide.
A two-month-old boy has a 4 cm right adrenal mass. Biopsy reveals
neuroblastoma.
There are metastases to the skin, liver, and bone marrow. Skeletal
survey is negative. The next step is:
A. observation.
B. flank XRT.
C. multi-agent chemotherapy.
D. right adrenalectomy.
E. total body XRT and bone marrow transplant

Correct answer : A

This infant has stage 4-5 neuroblastoma.

This can include involvement of skin, liver, and bone marrow

without bone metastases on skeletal survey.

Observation therapy alone in children < one year of age is usually

sufficient and metastases regress spontaneously, and therefore, do
not require any of the other options at this time.

In older children, or in cases where metastasesdo not regress,

chemotherapy is used. Inthis patient, there is no role for XRT or
adrenalectomy