[size=20px]A three-year old female presents with large abdominal masses and the computerized tomography (CT) scan shown below. The next best step in management of this child with bilateral renal masses is

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[size=20px]A systemic chemotherapy

 

B needle biopsy

 

C open wedge biopsy

 

D unilateral nephrectomy

 

E bilateral nephrectomy​​[/size]

systemic chemotherapy

A

A chemotherapy

A

A

Systemic chemotherapy

A systemic chemotherapy

A

A

A

A

A

correct answer

A systemic chemotherapy

 

The computerized tomography scan in this clinical circumstance is most suggestive of bilateral Wilms tumors. According to the current Children’s Oncology Group (COG) guidelines, rather than proceed to biopsy or attempted resection, the most appropriate treatment is to initiate systemic chemotherapy. Although the incidence of end stage renal failure remains higher in children with bilateral disease, preservation of renal parenchyma is possible in many patients after initial preoperative chemotherapy. If the tumors fail to respond with a 50% reduction after six weeks, bilateral biopsy may be required to define the pathology and adjust the chemotherapeutic regimen. Unfortunately, event free and overall survival remain lower for bilateral tumors compared to unilateral disease for all stages except stage IV.