# Wilms Tumor — GCMD Library living collection

Also covered as: hypertension · neuroblastoma · favorable histology Wilms tumor · cardiovascular disease · breast cancer · anaplastic Wilms tumor · unilateral Wilms tumor · renal dysfunction

Experts: Dr. Todd Ponsky, Dr. Peter Ehrlich, Dr. Tony Sandler, Dr. Greg Tiao

Updated: n/a · 20 episodes · 391 cited statements

## Episodes
### Foundations
- [Wilms Tumor](https://library.globalcastmd.com/watch/wilms-tumor-2533) — video · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-2533.md)
- [Topics in 10: Wilms Tumor](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583) — podcast · 12:29 · [machine version](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583.md)
- [Hepatoblastoma with Dr. Greg Tiao](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256) — video · [machine version](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256.md)

### Medical Management
- [Update Course Rewind: Updates in Wilms Management 2024](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937) — video · 4:07 · [machine version](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937.md)

### Complications
- [Long-Term Follow-Up of Surgical Outcomes for Patients With Wilms Tumor and Neuroblastoma](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581) — video · 1:04 · [machine version](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581.md)

### Evidence & Research
- [Wilms Tumor Protocol Violations: Practice Gap discussion at Update Course 2018](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345) — video · 9:55 · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345.md)
- [Wilms Tumor Protocol Violations: 2018 Pediatric Surgery Practice Gap #3](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460) — video · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460.md)
- [Non-Operative Management of Appendicitis: 2018 Pediatric Surgery Practice Gap #2](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462) — video · 1:21 · [machine version](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462.md)
- [Journal of Pediatric Surgery Article Highlights: April 2022](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554) — podcast · 8:38 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554.md)
- [Efficacy and late kidney effects of nephron-sparing surgery in the management of unilateral Wilms tumor](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077) — video · 0:53 · [machine version](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077.md)
- [Eficacia y efectos renales tardíos de la cirugía conservadora de nefronas en el tratamiento del tumor de Wilms unilateral: una revisión sistemática y un metanálisis](https://library.globalcastmd.com/watch/eficacia-y-efectos-renales-tard-os-de-la-cirug-a-conservadora-de-nefronas-en-el-tratamiento-del-tumor-de-wilms-unilateral-una-revisi-n-sistem-tica-y-un-metan-lisis-8079) — video · 1:02 · [machine version](https://library.globalcastmd.com/watch/eficacia-y-efectos-renales-tard-os-de-la-cirug-a-conservadora-de-nefronas-en-el-tratamiento-del-tumor-de-wilms-unilateral-una-revisi-n-sistem-tica-y-un-metan-lisis-8079.md)
- [Quick Literature Updates Ep 21](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050) — video · 4:04 · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050.md)
- [Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371) — video · 1:06 · [machine version](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371.md)
- [Impact of Pulmonary Tumor Burden in Favorable Histology Wilms Tumor Outcomes: A Report From the Children's Oncology Group Study AREN053](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658) — video · 1:15 · [machine version](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658.md)

### Case-Based Learning
- [Compiled Sandler Rapid Fire Sessions: Update Course 2015](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992) — video · 29:44 · [machine version](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992.md)
- [Wilms Tumor Rapid Fire: Update Course 2015](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993) — video · 8:46 · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993.md)
- [Neuroblastoma](https://library.globalcastmd.com/watch/neuroblastoma-1620) — podcast · 56:19 · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-1620.md)

### In-Depth Reviews
- [Wilms Tumor: Audio Chapter](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926) — podcast · 64:03 · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926.md)
- [Wilms Tumor: Audio Chapter](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487) — podcast · 64:03 · [machine version](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487.md)

### Emerging & Future Directions
- [Updated Favorable histology Wilms tumor risk stratification: Rationale for future Children’s Oncology Group clinical trials](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856) — video · 0:53 · [machine version](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=0) Long-Term Surgical Outcomes in Wilms Tumor and Neuroblastoma Survivors (Ep 18)
- [0:00](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=0) Prognostic Factors in Favorable Histology Wilms Tumor with Lung Metastases (Ep 19)
- [0:00](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=0) Updated Wilms Tumor Risk Stratification (Ep 20)
- [0:00](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=0) Introduction and Differential Diagnosis (Ep 2)
- [4:50](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=290) Initial Workup and COG Treatment Philosophy (Ep 2)
- [10:12](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=612) Biopsy Indications and Staging Systems (Ep 2)
- [19:34](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1174) COG Staging System and Treatment Implications (Ep 2)
- [28:51](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1731) SIOP Protocol and Preoperative Preparation (Ep 2)
- [36:03](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2163) Surgical Technique for Nephrectomy (Ep 2)
- [43:29](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2609) Surgery-Only Treatment and IVC Thrombus Management (Ep 2)
- [52:29](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3149) Pathology and Risk Stratification (Ep 2)
- [59:16](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3556) Bilateral Wilms Tumor Management (Ep 2)
- [0:04](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=4) Non-Operative Management of Appendicitis as 2018 Practice Gap #2 (Ep 6)
- [0:00](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=0) Social Determinants and Pediatric Oncology Survival (Ep 17)
- [0:00](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=0) Initial presentation and management decision (Ep 4)
- [1:45](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=105) Management of chemotherapy-resistant bilateral disease (Ep 4)
- [3:41](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=221) Surgical approach and pathology results (Ep 4)
- [5:19](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=319) Management of residual kidney after anaplastic pathology (Ep 4)
- [7:38](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=458) Outcomes and summary principles (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=0) Bilateral Wilms Tumor Management (Ep 3)
- [9:26](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=566) Gastroschisis Closure Techniques (Ep 3)
- [19:55](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1195) Ileal Atresia and Apple Peel Deformity (Ep 3)
- [28:40](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1720) Closing Remarks (Ep 3)
- [0:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=3) Introduction and Wilms Tumor Article (Ep 12)
- [2:10](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=130) Fetal Myelomeningocele Repair with Stem Cells (Ep 12)
- [4:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=277) Fetal Surgery Subspecialization Survey (Ep 12)
- [0:00](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=0) Nephron-sparing surgery versus radical nephrectomy in unilateral Wilms tumor (Ep 13)
- [0:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=0) Introduction and Case Presentation (Ep 15)
- [1:17](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=77) Case Management and Genetic Markers (Ep 15)
- [2:43](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=163) Biology-Driven Treatment Decisions (Ep 15)
- [3:30](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=210) Summary of Treatment Paradigms (Ep 15)
- [0:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=16) VTE Prophylaxis in Pediatric Trauma (Ep 16)
- [1:44](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=104) Fertility Preservation in Childhood Cancer (Ep 16)
- [2:47](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=167) Nephron-Sparing Surgery for Wilms Tumor (Ep 16)
- [0:01](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=1) Case Presentation and Audience Polling (Ep 1)
- [1:52](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=112) Lymph Node Sampling Requirement and Protocol Differences (Ep 1)
- [4:33](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=273) Management of Pulmonary Metastases (Ep 1)
- [7:12](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=432) Resolution Criteria and Educational Impact (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0) Wilms Tumor Protocol Violations Overview (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=0) Introduction and Epidemiology (Ep 7)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "This single institution cohort followed survivors for a mean of 27 years after open oncologic resection for Wilms tumor and neuroblastoma" — Sophia Schermerhorn (epidemiological) [Ep 18 · 0:11](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=11)
- "14% of patients required a repeat laparotomy" — Sophia Schermerhorn (epidemiological) [Ep 18 · 0:20](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=20)
- "The most common indications for repeat laparotomy were small bowel obstruction or tumor recurrence" — Sophia Schermerhorn (clinical) [Ep 18 · 0:21](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=21)
- "In Wilms tumor, obstruction typically occurred within the first year" — Sophia Schermerhorn (clinical) [Ep 18 · 0:26](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=26)
- "In neuroblastoma, obstruction often developed more than a decade later, well beyond routine follow-up" — Sophia Schermerhorn (clinical) [Ep 18 · 0:29](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=29)
- "Radiation dose was not associated with re-operation risk" — Sophia Schermerhorn (clinical) [Ep 18 · 0:34](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=34)
- "Secondary malignancy was uncommon in this cohort" — Sophia Schermerhorn (epidemiological) [Ep 18 · 0:37](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=37)
- "Hypertension after nephrectomy was not increased compared to population norms" — Sophia Schermerhorn (clinical) [Ep 18 · 0:37](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=37)
- "Scoliosis occurred in roughly 10 to 13% of patients, higher than the general population" — Sophia Schermerhorn (epidemiological) [Ep 18 · 0:45](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=45)
- "Scoliosis has multi-factorial contributors including surgery and possibly radiation" — Sophia Schermerhorn (clinical) [Ep 18 · 0:45](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=45)
- "Even decades after treatment, these patients remain at risk for late complications that warrant long-term counseling and follow-up" — Sophia Schermerhorn (guideline) [Ep 18 · 0:58](https://library.globalcastmd.com/watch/long-term-follow-up-of-surgical-outcomes-for-patients-with-wilms-tumor-and-neuroblastoma-11581?t=58)
- "Dick et al. published a report from a Children's Oncology Group study in the Journal of Clinical Oncology in 2025" — Jill Knepprath (clinical) [Ep 19 · 0:14](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=14)
- "The study examined factors in patients with favorable histology Wilms tumor and pulmonary metastases and how those factors may affect outcomes" — Jill Knepprath (clinical) [Ep 19 · 0:19](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=19)
- "Factors studied included the number of metastases, the size of the metastases, and different biological markers" — Jill Knepprath (clinical) [Ep 19 · 0:30](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=30)
- "There was no difference in survival based on the number of metastases" — Jill Knepprath (clinical) [Ep 19 · 0:36](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=36)
- "Patients who had a rapid response to chemotherapy with larger nodules showed worse event-free survival" — Jill Knepprath (clinical) [Ep 19 · 0:41](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=41)
- "Patients with larger nodules and rapid response to chemotherapy showed no changes in overall survival" — Jill Knepprath (clinical) [Ep 19 · 0:41](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=41)
- "In multivariable models, neither the size nor the number of nodules had any effect on survival" — Jill Knepprath (clinical) [Ep 19 · 0:49](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=49)
- "1q gain was associated with worse event-free survival" — Jill Knepprath (clinical) [Ep 19 · 0:55](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=55)
- "1q gain was associated with worse overall survival" — Jill Knepprath (clinical) [Ep 19 · 0:55](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=55)
- "1q gain is the superior prognostic factor when compared to size and number of nodules in patients with favorable histology Wilms tumor and pulmonary metastases" — Jill Knepprath (clinical) [Ep 19 · 1:04](https://library.globalcastmd.com/watch/impact-of-pulmonary-tumor-burden-in-favorable-histology-wilms-tumor-outcomes-a-report-from-the-children-s-oncology-group-study-aren053-11658?t=64)
- "Risk stratification for Wilms tumor has evolved many times over the years." — Jill Knera (clinical) [Ep 20 · 0:00](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=0)
- "The Children's Oncology Group published updated risk stratification for patients with favorable histology Wilms tumor in Nature in June 2025." — Jill Knera (guideline) [Ep 20 · 0:09](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=9)
- "The new risk stratification model includes biological and clinical features that were not in the first generation risk stratification." — Jill Knera (guideline) [Ep 20 · 0:19](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=19)
- "The new model changes some of the older features or gets rid of them altogether." — Jill Knera (guideline) [Ep 20 · 0:27](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=27)
- "Factors being added are loss of heterozygosity of 11P15, 1Q gain, and lymph node involvement." — Jill Knera (guideline) [Ep 20 · 0:32](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=32)
- "Tumor nephrectomy weight is no longer included in the risk stratification." — Jill Knera (guideline) [Ep 20 · 0:41](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=41)
- "The model modified how histology and age are used to stratify certain patients." — Jill Knera (guideline) [Ep 20 · 0:43](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=43)
- "More changes are expected in the future as ongoing COG trials produce more results." — Jill Knera (opinion) [Ep 20 · 0:48](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=48)
- "In North America, the preferred approach for most renal tumors is primary total nephrectomy with ureterectomy and lymph node sampling" — Peter Ehrlich (guideline) [Ep 2 · 6:23](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=383)
- "Preoperative chemotherapy is recommended if tumor extends into IVC beyond the infrahepatic level, if tumor is so large it impairs respiratory status, if major liver or bowel resection would be required, or if only one functioning kidney exists" — Peter Ehrlich (guideline) [Ep 2 · 7:01](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=421)
- "Tumors between 13–15 centimeters or larger have higher risk of rupture and may warrant consideration of preoperative chemotherapy" — Peter Ehrlich (clinical) [Ep 2 · 14:33](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=873)
- "Biopsy is recommended when giving preoperative chemotherapy because imaging cannot distinguish between Wilms tumor, rhabdoid tumor, clear cell sarcoma, or determine favorable vs unfavorable histology" — Peter Ehrlich (guideline) [Ep 2 · 15:55](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=955)
- "Core needle biopsy requires at least 10 cores, with accuracy increasing between 10 and 20 cores; fine needle aspiration cannot diagnose anaplasia" — Peter Ehrlich (clinical) [Ep 2 · 17:33](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1053)
- "Stage 1 is tumor limited to kidney, completely resected, no capsular invasion, vessels not involved, negative margins and lymph nodes" — Peter Ehrlich (guideline) [Ep 2 · 20:00](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1200)
- "Stage 2 is completely resected tumor with regional extension such as capsular penetration or renal sinus invasion, but negative lymph nodes and margins" — Peter Ehrlich (guideline) [Ep 2 · 20:28](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1228)
- "Stage 3 includes biopsied tumors with gross residual, positive lymph nodes, peritoneal penetration, positive margins, microscopic residual from spillage, or piecemeal removal" — Peter Ehrlich (guideline) [Ep 2 · 21:00](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1260)
- "Stage 4 is hematogenous metastasis to lung, liver, bone, or brain; stage 5 is bilateral renal involvement" — Peter Ehrlich (guideline) [Ep 2 · 21:58](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1318)
- "Stage 1 or 2 abdominal disease without lung metastases receives only two-drug chemotherapy (vincristine and dactinomycin) for shorter duration without abdominal radiation" — Peter Ehrlich (guideline) [Ep 2 · 23:08](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1388)
- "The main late effects of concern are renal failure, second malignancies, pregnancy problems, hypertension, and cardiovascular disease, primarily driven by radiation and doxorubicin exposure" — Peter Ehrlich (clinical) [Ep 2 · 23:37](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1417)
- "If a patient has lung metastases but stage 1 or 2 abdominal disease after primary nephrectomy, they avoid abdominal radiation even though they receive three-drug chemotherapy for the lung disease" — Peter Ehrlich (guideline) [Ep 2 · 24:15](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1455)
- "In COG protocols, approximately 40% of patients with pulmonary metastases who achieve complete response by 6 weeks can avoid pulmonary radiation without compromising survival" — Peter Ehrlich (clinical) [Ep 2 · 26:24](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1584)
- "Fifteen percent of girls who receive pulmonary radiation for Wilms tumor develop breast cancer" — Peter Ehrlich (epidemiological) [Ep 2 · 26:08](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1568)
- "SIOP protocols use preoperative chemotherapy for all patients at higher doses than COG, with response assessment at 4 and 8 weeks before surgery" — Peter Ehrlich (guideline) [Ep 2 · 30:16](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1816)
- "SIOP classifies patients post-treatment as low risk (complete necrosis), intermediate risk (based on blastema percentage), or high risk (predominantly blastema or anaplasia)" — Peter Ehrlich (guideline) [Ep 2 · 31:19](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1879)
- "In stage 3 disease, the main prognostic factor is lymph node status, followed by loss of heterozygosity at 1p and 16q, and 1q gain" — Peter Ehrlich (clinical) [Ep 2 · 32:45](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=1965)
- "Attempting resection and having to bail out with biopsy does not worsen prognosis compared to empiric biopsy for stage 3 disease" — Peter Ehrlich (clinical) [Ep 2 · 33:34](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2014)
- "Some Wilms tumor patients develop acquired von Willebrand disease; while usually clinically insignificant, rare cases have had significant intraoperative bleeding" — Peter Ehrlich (clinical) [Ep 2 · 35:11](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2111)
- "Right-sided tumors can distort anatomy leading to potential duodenal injury, superior mesenteric artery injury, or IVC injury" — Peter Ehrlich (clinical) [Ep 2 · 36:25](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2185)
- "The classic Wilms tumor surgical approach involves transverse or subcostal incision, mobilizing the kidney onto its pedicle, then identifying and dividing the ureter distally, followed by hilar vessel control" — Peter Ehrlich (clinical) [Ep 2 · 37:19](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2239)
- "Adrenalectomy is not necessary; there are no reports of adrenal insufficiency and adrenal vein tumor presence does not correlate with outcomes" — Peter Ehrlich (clinical) [Ep 2 · 39:23](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2363)
- "Lymph node sampling should aim for at least 5–6 nodes from the renal hilum and para-aortic or paracaval regions" — Peter Ehrlich (guideline) [Ep 2 · 39:49](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2389)
- "Taking a rim of diaphragm or small piece of liver to avoid violating tumor capsule does not upstage the tumor if the tumor itself is not divided" — Peter Ehrlich (clinical) [Ep 2 · 42:31](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2551)
- "Very low-risk patients (less than 2 years old, tumor less than 550 grams, stage 1, favorable histology) can be treated with surgery alone with greater than 95% survival" — Peter Ehrlich (clinical) [Ep 2 · 43:32](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2612)
- "The 10% of very low-risk patients who relapse after surgery alone have 100% salvage survival with chemotherapy" — Peter Ehrlich (clinical) [Ep 2 · 45:01](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2701)
- "IVC tumor extension is not a negative prognostic factor if the tumor can be completely resected" — Peter Ehrlich (clinical) [Ep 2 · 46:14](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2774)
- "For infrahepatic IVC thrombus, the ideal technique is to mobilize the kidney, ligate the renal artery, make a small nick in the renal vein, and slide the thrombus out in one piece" — Peter Ehrlich (clinical) [Ep 2 · 47:07](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2827)
- "Major complication rates including mortality, transfusions, and ICU stay increase significantly when IVC thrombus extends above the infrahepatic level" — Peter Ehrlich (clinical) [Ep 2 · 47:43](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2863)
- "In the largest series of IVC thrombus extending beyond infrahepatic cava treated with primary surgery, there was 26–30% major morbidity and some mortality" — Peter Ehrlich (epidemiological) [Ep 2 · 48:49](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2929)
- "Intraoperative ultrasound is used to assess the superior extent of IVC thrombus and determine if partial or complete caval occlusion is needed for resection" — Peter Ehrlich (clinical) [Ep 2 · 49:47](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=2987)
- "Loss of heterozygosity at both 1p and 16q occurs in 5–7% of patients and is associated with 10% worse survival in stage 1–2 and 18% worse in stage 3–4" — Peter Ehrlich (clinical) [Ep 2 · 54:41](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3281)
- "Patients with loss of heterozygosity at 1p and 16q receive intensified treatment: stage 1–2 get three drugs instead of two, stage 3–4 get five-drug regimen M" — Peter Ehrlich (guideline) [Ep 2 · 55:23](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3323)
- "Unfavorable histology is classified as focal or diffuse anaplasia based on the number of high-power fields showing anaplastic features" — Peter Ehrlich (clinical) [Ep 2 · 55:58](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3358)
- "Clear cell sarcoma of the kidney has reasonable treatment outcomes particularly for low stages, while rhabdoid tumors have terrible outcomes except for stage 1" — Peter Ehrlich (clinical) [Ep 2 · 57:01](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3421)
- "Bilateral Wilms tumors occur in 8–10% of all Wilms tumor cases" — Peter Ehrlich (epidemiological) [Ep 2 · 57:46](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3466)
- "The strategy for bilateral Wilms is preoperative chemotherapy to shrink tumors enough to allow partial nephrectomy on at least one kidney, avoiding dialysis" — Peter Ehrlich (guideline) [Ep 2 · 58:07](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3487)
- "Historical outcomes for bilateral Wilms tumor were significantly worse than unilateral: 61% event-free survival and 80% overall survival compared to 88% and 95% respectively" — Peter Ehrlich (epidemiological) [Ep 2 · 58:51](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3531)
- "The COG bilateral Wilms study used VAD induction chemotherapy with response assessment at 6 and 12 weeks, as maximum response typically occurs by 12 weeks" — Peter Ehrlich (guideline) [Ep 2 · 59:19](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3559)
- "In typical bilateral Wilms presentations (under 36 months, classic imaging), biopsy is not required as it is almost universally Wilms tumor; only 1 of 250 enrolled patients had rhabdoid tumor" — Peter Ehrlich (clinical) [Ep 2 · 60:29](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3629)
- "Biopsy is recommended for atypical bilateral presentations: older children (8–10 years) or those with syndromes like von Hippel-Lindau where renal cell carcinoma is more likely" — Peter Ehrlich (guideline) [Ep 2 · 61:56](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3716)
- "When biopsying bilateral disease, both kidneys should be biopsied as there is discordant pathology in up to 20% of cases" — Peter Ehrlich (clinical) [Ep 2 · 62:14](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-926?t=3734)
- "Non-operative management of perforated appendicitis has been known for a long time." (clinical) [Ep 6 · 0:19](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=19)
- "Treating appendicitis with antibiotics had equal outcome measures compared to initial operative management." (clinical) [Ep 6 · 0:19](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=19)
- "There was a 15% risk of recurrence of appendicitis at one-year follow-up with non-operative management." (clinical) [Ep 6 · 0:35](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=35)
- "Non-operative management resulted in decreased hospital stays compared to operative management." (clinical) [Ep 6 · 0:35](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=35)
- "Non-operative management resulted in decreased days of disability compared to operative management." (clinical) [Ep 6 · 0:35](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=35)
- "Non-operative management of appendicitis is an option with risks and benefits that need to be taken into account." (guideline) [Ep 6 · 0:52](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=52)
- "APSA was not making a flat out recommendation to start doing non-operative appendicitis." — Gibbons (opinion) [Ep 6 · 1:08](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=68)
- "The data on non-operative appendicitis management is becoming more clear." — Gibbons (opinion) [Ep 6 · 1:14](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=74)
- "The choice between operative and non-operative appendicitis management remains dealer's choice." — Gibbons (opinion) [Ep 6 · 1:06](https://library.globalcastmd.com/watch/non-operative-management-of-appendicitis-2018-pediatric-surgery-practice-gap-2-1462?t=66)
- "Study was a retrospective analysis of 12,000 patients with neuroblastoma, Wilms tumor, and hepatoblastoma from the National Cancer Database" — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:12](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=12)
- "Socioeconomic disadvantage score was created for each patient based on median household income and education level in their local communities" — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:20](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=20)
- "The most disadvantaged children were more likely to have worse survival for Wilms tumor and neuroblastoma" — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:31](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=31)
- "After adjusting for tumor size, grade, treatment, and comorbidities, socioeconomic effects on survival remained present" — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:37](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=37)
- "Hazard ratio for socioeconomic disadvantage was 2.02 for Wilms tumor" — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:44](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=44)
- "Hazard ratio for socioeconomic disadvantage was 1.29 for hepatoblastoma" — Sophia Schermerhorn (epidemiological) [Ep 17 · 0:44](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=44)
- "Pediatric oncology outcomes depend on tumor biology, treatment received, and social determinants of health" — Sophia Schermerhorn (opinion) [Ep 17 · 0:51](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=51)
- "Identifying socioeconomic risk factors is necessary to close equity gaps and improve survival for all children with solid tumors" — Sophia Schermerhorn (opinion) [Ep 17 · 1:00](https://library.globalcastmd.com/watch/social-determinants-of-health-influence-on-survival-in-wilms-tumor-neuroblastoma-and-hepatoblastoma-11371?t=60)
- "Current standard for bilateral Wilms tumors with metastases is to start chemotherapy without biopsy" (guideline) [Ep 4 · 0:54](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=54)
- "Tumor shrinkage is defined as a decrease of 50% in tumor size" (clinical) [Ep 4 · 1:00](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=60)
- "When tumors stop shrinking after chemotherapy, surgical intervention is typically pursued, often because of mesenchymal differentiation rather than anaplastic tumor" (clinical) [Ep 4 · 3:41](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=221)
- "Bilateral nephron-sparing surgery is feasible in most cases of bilateral Wilms tumor" (clinical) [Ep 4 · 4:07](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=247)
- "Surgical technique for nephron-sparing involves placing kidneys on ice, clamping vessels, and sharp dissection to remove tumor" (clinical) [Ep 4 · 4:15](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=255)
- "Wilms tumors are heterogeneous and biopsy may miss foci of anaplasia" — Dan (clinical) [Ep 4 · 2:49](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=169)
- "More aggressive chemotherapy regimen may be considered if anaplastic elements are suspected and tumor is not responding" — Dan (clinical) [Ep 4 · 2:25](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=145)
- "Stage 3 local tumor requires radiation on both sides" (guideline) [Ep 4 · 5:03](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=303)
- "Anaplastic recurrence portends a very bad outcome" — Dan (clinical) [Ep 4 · 6:10](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=370)
- "Salvage is difficult with anaplastic tumor despite chemotherapy" — Dan (clinical) [Ep 4 · 6:18](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=378)
- "Philosophy for bilateral tumors is to preserve as much renal tissue as possible, which is why upfront biopsy is no longer performed" — Dan (guideline) [Ep 4 · 6:44](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=404)
- "If tumor is not responding to chemotherapy, tissue is needed to rule out anaplasia" — Dan (clinical) [Ep 4 · 6:56](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=416)
- "Once anaplastic tumor recurs, it is very hard to salvage" — Dan (clinical) [Ep 4 · 7:11](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=431)
- "Most pathologists think anaplasia is present primarily rather than induced by chemotherapy" (opinion) [Ep 4 · 7:24](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=444)
- "Multifocal tumors raise concern about underlying embryology of the kidney and risk for developing additional tumors" — Dan (clinical) [Ep 4 · 7:37](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=457)
- "Mutations in WT1 or WT2 increase risk for additional tumors" (clinical) [Ep 4 · 7:53](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=473)
- "97% of large bilateral kidney tumors in children are Wilms tumor" (epidemiological) [Ep 4 · 8:31](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=511)
- "Chemotherapy upfront is not always necessary for bilateral Wilms tumors given the high likelihood of Wilms diagnosis" (opinion) [Ep 4 · 8:31](https://library.globalcastmd.com/watch/wilms-tumor-rapid-fire-update-course-2015-993?t=511)
- "97% of bilateral large kidney tumors in children are Wilms tumor" — Tony Sandler (epidemiological) [Ep 3 · 9:12](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=552)
- "For bilateral Wilms tumors, chemotherapy is started without biopsy and continued until tumor shrinkage stops, typically defined as less than 50% volume reduction" — Tony Sandler (guideline) [Ep 3 · 1:32](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=92)
- "When bilateral Wilms tumors stop shrinking with chemotherapy, it is usually due to mesenchymal differentiation rather than anaplastic transformation" — Tony Sandler (clinical) [Ep 3 · 4:19](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=259)
- "Bilateral nephron-sparing surgery is achievable in most cases of large bilateral Wilms tumors using on-table renal hypothermia with ice and vascular clamping" — Tony Sandler (clinical) [Ep 3 · 4:44](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=284)
- "Wilms tumors are heterogeneous and biopsy may miss foci of anaplasia" — Dan (clinical) [Ep 3 · 3:27](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=207)
- "Anaplastic Wilms tumor recurrence portends a very bad outcome and salvage is difficult despite chemotherapy" — Dan (clinical) [Ep 3 · 6:48](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=408)
- "Most pathologists believe anaplasia in Wilms tumor is present primarily rather than induced by chemotherapy" — Tony Sandler (opinion) [Ep 3 · 7:56](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=476)
- "Multifocal renal tumors raise concern about underlying embryologic abnormalities and risk of developing additional tumors" — Dan (clinical) [Ep 3 · 8:15](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=495)
- "For gastroschisis with inflamed bowel, bedside reduction without intubation is possible in approximately 80% of cases" — Todd (clinical) [Ep 3 · 10:29](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=629)
- "Early delivery of gastroschisis cases results in less thick and matted bowel" (clinical) [Ep 3 · 11:11](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=671)
- "For gastroschisis closure without fascial incision, umbilical hernias that develop will typically close spontaneously over 3-5 years" — Tony Sandler (clinical) [Ep 3 · 12:54](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=774)
- "Spring-loaded Bianchi silos may enlarge the fascial defect due to outward radial forces from the compression ring" — Todd (opinion) [Ep 3 · 14:20](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=860)
- "Tegaderm dressing is left in place for approximately 3 days on gastroschisis closures, then converted to dry dressing when adherent" — Tony Sandler (clinical) [Ep 3 · 15:06](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=906)
- "Feeding can be started when bowel function returns in gastroschisis cases, without waiting for complete fascial closure" — Tony Sandler (clinical) [Ep 3 · 16:08](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=968)
- "For gastroschisis with atresia and pristine bowel, bringing an ostomy out through the umbilical fascial ring is technically advantageous" (clinical) [Ep 3 · 17:49](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1069)
- "Anastomosis in gastroschisis with atresia is technically difficult due to size mismatch between dilated proximal and decompressed distal bowel" (clinical) [Ep 3 · 18:36](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1116)
- "In gastroschisis with unclear atresia and inflamed bowel, reduction without anastomosis is preferred, with re-exploration at 4-6 weeks" — Tony Sandler (clinical) [Ep 3 · 19:14](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1154)
- "Closing fascia in gastroschisis increases intra-abdominal pressure compared to leaving it open with Tegaderm coverage" — Tony Sandler (clinical) [Ep 3 · 19:26](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1166)
- "Re-exploration at 2 weeks in complex gastroschisis can show transformation of inflamed bowel into viable intestine suitable for anastomosis" — Tony Sandler (clinical) [Ep 3 · 22:07](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1327)
- "For apple peel ileal atresia with ischemic distal bowel, resection is indicated rather than waiting for reperfusion if bowel does not pink up on the operating table" — Tony Sandler (clinical) [Ep 3 · 25:19](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1519)
- "Plication of dilated proximal bowel in neonatal atresia is preferred over tapering to preserve bowel length for potential future lengthening procedures" — Tony Sandler (clinical) [Ep 3 · 28:10](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1690)
- "The STEP registry discourages performing STEP procedures in the perinatal period due to poor outcomes" — Greg (guideline) [Ep 3 · 26:27](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1587)
- "STEP procedures in gastroschisis patients have limited benefit due to underlying motility disorders" — Greg (clinical) [Ep 3 · 26:33](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1593)
- "Bianchi procedure is preferred over STEP for initial bowel lengthening because it preserves the option for subsequent STEP, whereas STEP limits future lengthening options" — Greg (opinion) [Ep 3 · 26:46](https://library.globalcastmd.com/watch/compiled-sandler-rapid-fire-sessions-update-course-2015-992?t=1606)
- "The SIOP study examined children with Wilms tumor where tumor thrombus extended into the renal vein and provided outcomes for when complete resection was successful or unsuccessful" — Brittany Levy (clinical) [Ep 12 · 0:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=58)
- "Wilms tumor has been a great success story for pediatric surgery and pediatric oncology" — Brittany Levy (opinion) [Ep 12 · 1:14](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=74)
- "If half of Wilms tumor patients get complete tumor removal and half don't, and there is an outcome difference, then surgeons should still try hard to remove all of it" — Brittany Levy (clinical) [Ep 12 · 1:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=114)
- "The UC Davis study is a pivotal study in obtaining FDA approval for use of clinical grade stem cells in fetal myelomeningocele repair" — Christina Theodoro (guideline) [Ep 12 · 2:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=174)
- "The study represents being one step closer to first in human clinical trial for stem cell use in myelomeningocele repair" — Brittany Levy (clinical) [Ep 12 · 3:03](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=183)
- "In the ovine model, the extracellular matrix patch with placental stem cells is placed with cells facing the spinal cord in direct contact, then skin is closed and the fetus continues gestation until term" — Christina Theodoro (clinical) [Ep 12 · 3:27](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=207)
- "Lambs repaired with clinical grade placental stem cells have significantly improved motor function compared to lambs that did not receive stem cells" — Christina Theodoro (clinical) [Ep 12 · 3:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=234)
- "There is already shown benefit of repairing myelomeningocele in utero, and adding mesenchymal stromal cells provides even larger benefit in chance of ambulation" — Todd Ponsky (clinical) [Ep 12 · 4:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=248)
- "The fetal surgery survey was of non-trainee surgeons within the American Pediatric Surgical Association to gauge practice patterns in fetal surgery across the country" — Rod Gerardo (clinical) [Ep 12 · 4:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=298)
- "Only 4% of self-identified fetal surgery specialists reported receiving formal training in fetal surgery" — Natalie Lopian (epidemiological) [Ep 12 · 5:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=313)
- "Many survey respondents reported receiving fetal training during pediatric surgery fellowship, yet when asked differently, many responded they didn't have exposure to fetal surgery during fellowship" — Brittany Levy (epidemiological) [Ep 12 · 5:37](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=337)
- "Fetal surgery is a frontier for pediatric surgery and the survey provides a reality check on how to develop a treatment which remains rare and often experimental" — Brittany Levy (opinion) [Ep 12 · 5:54](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=354)
- "In an emerging field like fetal surgery, there are disparities in what is happening at different centers" — Todd Ponsky (opinion) [Ep 12 · 6:38](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=398)
- "There is value in having some centers with dedicated teams focusing on fetal care even if they don't do interventions" — Todd Ponsky (opinion) [Ep 12 · 6:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=406)
- "The survey results suggest people would not be interested in subspecialization for fetal surgery in America for a variety of reasons" — Brittany Levy (opinion) [Ep 12 · 7:04](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=424)
- "The study was not designed to link subspecialization of fetal surgery to outcomes and wasn't designed to provide a clear definition of a fetal surgery center" — Natalie Lopian (clinical) [Ep 12 · 7:26](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-highlights-april-2022-5554?t=446)
- "The systematic review and meta-analysis was conducted in Chongqing, China" — Cecilia Gigena (epidemiological) [Ep 13 · 0:12](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=12)
- "The study aimed to evaluate efficacy and long-term renal function after nephron-sparing surgery in patients with unilateral Wilms tumor" — Cecilia Gigena (clinical) [Ep 13 · 0:12](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=12)
- "The analysis included 26 studies" — Cecilia Gigena (epidemiological) [Ep 13 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- "Nephron-sparing surgery increased glomerular filtration rate after surgery" — Cecilia Gigena (clinical) [Ep 13 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- "There were no significant differences in overall survival between nephron-sparing surgery and radical nephrectomy" — Cecilia Gigena (clinical) [Ep 13 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- "There were no significant differences in recurrence rates between nephron-sparing surgery and radical nephrectomy" — Cecilia Gigena (clinical) [Ep 13 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- "There were no significant differences in hypertension rates between nephron-sparing surgery and radical nephrectomy" — Cecilia Gigena (clinical) [Ep 13 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- "There were no significant differences in renal dysfunction rates between nephron-sparing surgery and radical nephrectomy" — Cecilia Gigena (clinical) [Ep 13 · 0:27](https://library.globalcastmd.com/watch/efficacy-and-late-kidney-effects-of-nephron-sparing-surgery-in-the-management-of-unilateral-wilms-tumor-8077?t=27)
- "European colleagues would offer chemotherapy without biopsy for suspected Wilms tumor" (guideline) [Ep 15 · 0:53](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=53)
- "At COG (Children's Oncology Group) sites in North America, the approach would be resection at diagnosis" (guideline) [Ep 15 · 1:00](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=60)
- "Adding doxorubicin would be indicated even for a low stage tumor under certain conditions" (clinical) [Ep 15 · 1:17](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=77)
- "Loss of heterozygosity is the loss of genetic diversity in tumor cells" — Lizzie Lee (clinical) [Ep 15 · 1:54](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=114)
- "In Wilms tumor, loss of heterozygosity can indicate more aggressive disease" — Lizzie Lee (clinical) [Ep 15 · 1:58](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=118)
- "Gain of 1Q refers to an extra copy of a section of chromosome 1, which is linked to worse outcomes in some cancers" — Lizzie Lee (clinical) [Ep 15 · 2:02](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=122)
- "Doxorubicin should be added when there is loss of heterozygosity at 1P and 16Q" — Bargaba Mulaudi (clinical) [Ep 15 · 2:18](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=138)
- "Loss of heterozygosity at 1P and 16Q shows higher recurrence" — Bargaba Mulaudi (clinical) [Ep 15 · 2:25](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=145)
- "For surgeons, there will be more waiting for biology results before determining if chemotherapy is needed" (clinical) [Ep 15 · 2:43](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=163)
- "When considering port placement, there will be more of a wait-and-see approach to review biologic markers" (clinical) [Ep 15 · 2:51](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=171)
- "It is not accurate to tell families that patients under 2 years of age with tumors under 550g will not need chemotherapy, because biology studies may change that determination" — Bargaba Mulaudi (clinical) [Ep 15 · 2:56](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=176)
- "Chemotherapy must be added if there is loss of heterozygosity at 1P and 16Q" — Bargaba Mulaudi (clinical) [Ep 15 · 3:09](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=189)
- "According to Children's Oncology Group updates, adverse biologic factors are associated with worse prognosis in stage 2 patients" — Lizzie Lee (guideline) [Ep 15 · 3:15](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=195)
- "Adverse biologic factors are not associated with worse prognosis in stage 1 favorable histology Wilms tumor patients" — Lizzie Lee (guideline) [Ep 15 · 3:15](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=195)
- "Even with stage 1 favorable histology, chemotherapy is still added if there is loss of heterozygosity" — Bargaba Mulaudi (clinical) [Ep 15 · 3:26](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=206)
- "The North American Children's Oncology Group approach often involves immediate surgery" — Lizzie Lee (guideline) [Ep 15 · 3:37](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=217)
- "The European Society of Pediatric Oncology approach typically starts with chemotherapy before surgery" — Lizzie Lee (guideline) [Ep 15 · 3:37](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=217)
- "Genetic markers like loss of heterozygosity at specific chromosomes can indicate a higher risk of cancer recurrence" — Lizzie Lee (clinical) [Ep 15 · 3:49](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=229)
- "Genetic markers guide decisions about adding chemotherapy treatments" — Lizzie Lee (clinical) [Ep 15 · 3:49](https://library.globalcastmd.com/watch/update-course-rewind-updates-in-wilms-management-2024-10937?t=229)
- "Pediatric trauma patients are at high risk for developing venous thromboembolism" — Lizzie Lee (clinical) [Ep 16 · 1:02](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=62)
- "The cohort study included patients younger than 18 years old from eight pediatric trauma centers between 2019 and 2022" — Lizzie Lee (epidemiological) [Ep 16 · 1:09](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=69)
- "Among 460 high-risk patients, more than half received chemical VTE prophylaxis" — Lizzie Lee (epidemiological) [Ep 16 · 1:18](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=78)
- "Delaying blood thinners beyond 24 hours of hospital arrival increases the risk of blood clots" — Lizzie Lee (clinical) [Ep 16 · 1:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=85)
- "VTE prophylaxis is safe and effective for pediatric trauma patients when started within 24 hours of admission" — Lizzie Lee (clinical) [Ep 16 · 1:32](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=92)
- "The systematic review initially reviewed 104 abstracts and 34 full text articles, ultimately including 12 studies" — Alex Halpern (epidemiological) [Ep 16 · 2:08](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=128)
- "Ovarian tissue cryopreservation was performed in 501 patients" — Alex Halpern (epidemiological) [Ep 16 · 2:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=136)
- "5.9% of patients who underwent ovarian tissue cryopreservation subsequently underwent ovarian tissue transplantation" — Alex Halpern (epidemiological) [Ep 16 · 2:16](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=136)
- "33% of patients who underwent ovarian tissue transplantation were able to become pregnant" — Alex Halpern (clinical) [Ep 16 · 2:27](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=147)
- "Ovarian tissue cryopreservation has advantages for pediatric cancer patients but needs further study" — Alex Halpern (opinion) [Ep 16 · 2:33](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=153)
- "The meta-analysis gathered 26 studies evaluating nephron-sparing surgery in unilateral Wilms tumor" — Cecilia Gigena (epidemiological) [Ep 16 · 3:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=205)
- "Nephron-sparing surgery increased glomerular filtration after surgery" — Cecilia Gigena (clinical) [Ep 16 · 3:25](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=205)
- "Nephron-sparing surgery showed no significant differences in overall survival compared to radical nephrectomy" — Cecilia Gigena (clinical) [Ep 16 · 3:37](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=217)
- "Nephron-sparing surgery showed no significant differences in recurrences compared to radical nephrectomy" — Cecilia Gigena (clinical) [Ep 16 · 3:37](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=217)
- "Nephron-sparing surgery showed no significant differences in hypertension compared to radical nephrectomy" — Cecilia Gigena (clinical) [Ep 16 · 3:37](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=217)
- "Nephron-sparing surgery showed no significant differences in renal dysfunction compared to radical nephrectomy" — Cecilia Gigena (clinical) [Ep 16 · 3:37](https://library.globalcastmd.com/watch/quick-literature-updates-ep-21-11050?t=217)
- "When doing a nephrectomy for Wilms tumor, lymph nodes must be sampled according to protocols" (guideline) [Ep 1 · 1:54](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=114)
- "If lymph nodes are not documented as histologically negative, they are assumed to be positive, which bumps up the stage and requires increased chemotherapy" (guideline) [Ep 1 · 2:01](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=121)
- "Failure to sample lymph nodes during Wilms nephrectomy is an identified practice gap by the Cancer Committee and COG publications" (epidemiological) [Ep 1 · 2:19](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=139)
- "The management approach is based on US protocols as opposed to European SIOP protocols" (guideline) [Ep 1 · 2:30](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=150)
- "In Hong Kong, they tend to go with the American protocol for Wilms tumor but use either European or American protocols for various other tumors" — Ken Wong (clinical) [Ep 1 · 3:23](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=203)
- "Just because you have metastatic disease in the lung doesn't mean you shouldn't treat the primary with a nephrectomy" (guideline) [Ep 1 · 4:07](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=247)
- "Primary nephrectomy changes whether or not the patient will get radiation therapy" (clinical) [Ep 1 · 4:20](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=260)
- "There is a local stage for Wilms tumor and a patient staging for Wilms tumor" (clinical) [Ep 1 · 4:26](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=266)
- "On the ACS pediatric surgery blog, overwhelmingly the presence of lymph node mets meant people did biopsy and chemotherapy, which is incorrect" (epidemiological) [Ep 1 · 4:33](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=273)
- "Regardless of pulmonary metastatic disease, if you think you have a primary that can come out without removing other organs, you should do that because it decreases radiation therapy" (guideline) [Ep 1 · 4:44](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=284)
- "The child will get metastatic stage 4 chemotherapy no matter what, but biopsy counts as local spillage and requires radiation therapy to the flank or abdomen" (clinical) [Ep 1 · 5:04](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=304)
- "You should treat local disease differently than systemic disease" (guideline) [Ep 1 · 5:17](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=317)
- "Whether to biopsy lung masses depends on how many are present; with multiple lesions, a correct assumption of metastatic disease can be made" (clinical) [Ep 1 · 5:20](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=320)
- "Oncologists want measurable disease to see if it responds to chemotherapy" (clinical) [Ep 1 · 5:45](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=345)
- "If you treat the patient and lung nodules go away, you presume that is metastatic disease; if there is a residual nodule after treatment, that is an indication to resect it" — Dan (clinical) [Ep 1 · 6:03](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=363)
- "Previously, if a nodule wasn't present on plain film, it didn't matter even if seen on CT, but now CT is the diagnostic test of choice and impacts therapy" — Dan (clinical) [Ep 1 · 6:24](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=384)
- "For single nodules, patients are treated and if the nodule resolves, it is presumed to be metastatic Wilms tumor" — Dan (clinical) [Ep 1 · 6:41](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=401)
- "There are radiographic criteria for single nodules; if it looks like a met you treat it, if it doesn't look like a met you can biopsy it to prove it's not a met and avoid chemotherapy" (clinical) [Ep 1 · 6:54](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=414)
- "What you avoid with nodule resolution is radiation therapy to the lungs, not chemotherapy" — Dan (clinical) [Ep 1 · 7:12](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=432)
- "If after 6 weeks lung nodules have resolved regardless of number, there is no radiation to the lungs" — Dan (clinical) [Ep 1 · 7:18](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=438)
- "To avoid radiation, lung nodules have to disappear; if there is a residual nodule you don't know if it's scar or active tumor and have to biopsy" — Dan (clinical) [Ep 1 · 7:43](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=463)
- "Nodules have to resolve to avoid radiation therapy" — Dan (clinical) [Ep 1 · 7:58](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=478)
- "In SIOP protocols, they do a percutaneous biopsy of the tumor and treat with chemotherapy" (guideline) [Ep 1 · 8:01](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=481)
- "APSA has addressed the lymph node sampling practice gap through expert questions, educational efforts at annual meetings, and the American College of Surgeons registry has seen improvement with fewer patients getting nephrectomies without lymph node sampling" (epidemiological) [Ep 1 · 9:29](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-practice-gap-discussion-at-update-course-2018-345?t=569)
- "Lymph nodes must be taken out during nephrectomy for Wilms tumor" (guideline) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- "Failure to take out lymph nodes automatically upstages Wilms tumor patients" (guideline) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- "There is both a local and systemic staging system for Wilms tumor" (clinical) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- "Pulmonary metastases do not preclude primary nephrectomy in Wilms tumor" (guideline) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- "Primary nephrectomy in metastatic Wilms tumor affects whether the patient receives radiation therapy" (clinical) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=0)
- "There is a local stage for Wilms tumor and a patient staging for Wilms tumor" — Erlick (clinical) [Ep 5 · 0:50](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=50)
- "Omission of lymph node biopsies is a major protocol violation in Wilms tumor surgery" — Erlick (opinion) [Ep 5 · 0:50](https://library.globalcastmd.com/watch/wilms-tumor-protocol-violations-2018-pediatric-surgery-practice-gap-3-1460?t=50)
- "Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall" — Andrew Davidoff (epidemiological) [Ep 7 · 0:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=0)
- "Approximately 75% of Wilms tumor cases occur in children younger than five years of age with a peak incidence at two to three years of age" — Andrew Davidoff (epidemiological) [Ep 7 · 0:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=30)
- "Survival for patients with Wilms tumor when considered as a whole is currently greater than 90%" — Andrew Davidoff (epidemiological) [Ep 7 · 1:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=60)
- "Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality" — Andrew Davidoff (epidemiological) [Ep 7 · 1:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=80)
- "Children with Wilms tumor typically present with an asymptomatic abdominal mass" — Andrew Davidoff (clinical) [Ep 7 · 3:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=180)
- "Associated signs and symptoms such as malaise, pain, microscopic or gross hematuria are found in only about 25% of children with Wilms tumor, as is hypertension" — Andrew Davidoff (clinical) [Ep 7 · 3:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=200)
- "CT of the abdomen and pelvis is generally the definitive imaging study of choice for patients suspected of having a renal tumor based on ultrasound" — Andrew Davidoff (guideline) [Ep 7 · 4:10](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=250)
- "Intravascular tumor extension occurs in about 6% of Wilms tumor cases" — Andrew Davidoff (epidemiological) [Ep 7 · 5:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=320)
- "The most common site of metastatic spread of Wilms tumor is the lungs" — Andrew Davidoff (clinical) [Ep 7 · 6:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=380)
- "Stage one Wilms tumors are localized tumors confined within the renal capsule" — Andrew Davidoff (guideline) [Ep 7 · 7:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=440)
- "Stage two Wilms tumors penetrate the renal capsule but are resected with negative margins" — Andrew Davidoff (guideline) [Ep 7 · 7:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=460)
- "Stage three criteria include biopsy or rupture (pre-operative or intraoperative), positive resection margin or gross residual disease, lymph node involvement, or administration of preoperative chemotherapy" — Andrew Davidoff (guideline) [Ep 7 · 8:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=480)
- "Metastatic disease occurs in about 12% of Wilms tumor patients and is considered stage four" — Andrew Davidoff (epidemiological) [Ep 7 · 8:50](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=530)
- "Patients with synchronous bilateral Wilms tumor are stage five" — Andrew Davidoff (guideline) [Ep 7 · 9:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=560)
- "For unilateral tumors, up-front resection with regional lymph node sampling is currently the recommendation from the Children's Oncology Group" — Andrew Davidoff (guideline) [Ep 7 · 10:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=620)
- "Most Wilms tumors are resectable at presentation because even large tumors rarely invade surrounding structures" — Andrew Davidoff (clinical) [Ep 7 · 11:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=680)
- "Failure to perform up-front resection and instead administering neoadjuvant chemotherapy results in classification as stage three, mandating flank radiation and doxorubicin" — Andrew Davidoff (guideline) [Ep 7 · 11:50](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=710)
- "Treatment of favorable histology stage one or two Wilms tumor is limited to vincristine and actinomycin D" — Andrew Davidoff (guideline) [Ep 7 · 12:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=760)
- "For stage one tumors weighing less than 550 grams (tumor plus kidney) in patients less than 2 years of age, no adjuvant chemotherapy is given" — Andrew Davidoff (guideline) [Ep 7 · 13:05](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=785)
- "Lymph node involvement is associated with increased incidence of tumor relapse and poorer prognosis" — Andrew Davidoff (clinical) [Ep 7 · 14:10](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=850)
- "Lymph node sampling should be performed even in the absence of abnormal nodes on pre-operative imaging or gross inspection because these circumstances don't reliably predict lymph node negativity" — Andrew Davidoff (guideline) [Ep 7 · 14:35](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=875)
- "Partial nephrectomy for patients with unilateral non-syndromic disease or laparoscopic nephrectomy are not currently standard of care and should generally only be performed in the context of a clinical trial" — Andrew Davidoff (guideline) [Ep 7 · 15:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=920)
- "About 5% of children with Wilms tumor present with synchronous bilateral disease or stage five disease" — Andrew Davidoff (epidemiological) [Ep 7 · 16:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=980)
- "Patients with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs to shrink tumors and facilitate preservation of normal renal parenchyma" — Andrew Davidoff (guideline) [Ep 7 · 16:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1000)
- "A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis" — Andrew Davidoff (guideline) [Ep 7 · 17:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1060)
- "Biopsies of bilateral renal masses rarely detect anaplasia even when it exists in the tumor mass" — Andrew Davidoff (clinical) [Ep 7 · 18:15](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1095)
- "A biopsy if performed in bilateral disease doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor" — Andrew Davidoff (guideline) [Ep 7 · 18:35](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1115)
- "Bilateral nephron sparing surgery should be considered in all patients with bilateral Wilms tumor after either six or 12 weeks of neoadjuvant chemotherapy" — Andrew Davidoff (guideline) [Ep 7 · 19:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1140)
- "Longer courses of pre-operative chemotherapy than 12 weeks are definitely discouraged in bilateral Wilms tumor" — Andrew Davidoff (guideline) [Ep 7 · 19:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1170)
- "Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor" — Andrew Davidoff (clinical) [Ep 7 · 20:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1230)
- "Primary resection of tumors with extension above the level of the hepatic veins or into the atrium is associated with higher operative morbidity" — Andrew Davidoff (clinical) [Ep 7 · 21:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1280)
- "Neoadjuvant chemotherapy is generally used for intravascular tumor extension above the hepatic veins or into the atrium" — Andrew Davidoff (guideline) [Ep 7 · 21:50](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1310)
- "Thrombus extending above the hepatic veins that persists after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove" — Andrew Davidoff (guideline) [Ep 7 · 22:10](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1330)
- "About 12% of Wilms tumor patients have evidence of hematogenous metastasis at diagnosis with 80% being pulmonary metastasis" — Andrew Davidoff (epidemiological) [Ep 7 · 23:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1380)
- "Stage four patients with radiographic disappearance of lung metastasis or tissue confirmation of no viable tumor at week six are considered rapid responders and continue three drug chemotherapy" — Andrew Davidoff (guideline) [Ep 7 · 23:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1420)
- "Slow or incomplete responders to initial therapy are switched to more intensive chemotherapy and receive whole lung radiation" — Andrew Davidoff (guideline) [Ep 7 · 24:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1470)
- "Hepatoblastoma is the most common malignant liver tumor in the pediatric population" (epidemiological) [Ep 11 · 0:00](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=0)
- "There are around 250 new cases of hepatoblastoma per year" (epidemiological) [Ep 11 · 0:20](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=20)
- "Treatment strategies for hepatoblastoma have changed dramatically over the past 25 years" (clinical) [Ep 11 · 0:10](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=10)
- "Hepatoblastoma is nowhere near the most common liver tumor or the most common abdominal tumor in children" — Greg Tiao (epidemiological) [Ep 11 · 0:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=46)
- "Neuroblastoma is the most common solid malignancy in the pediatric population" (epidemiological) [Ep 11 · 1:14](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=74)
- "Hemangioma is the most common liver lesion in children" (epidemiological) [Ep 11 · 1:40](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=100)
- "Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, or respiratory distress due to tumor size" — Greg Tiao (clinical) [Ep 11 · 2:20](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=140)
- "Hepatoblastoma can present as a paraneoplastic syndrome like precocious puberty" (clinical) [Ep 11 · 2:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166)
- "An elevated alpha fetoprotein (AFP) is a key component in the workup and is critical for the diagnostic algorithm and treatment response" (clinical) [Ep 11 · 2:46](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=166)
- "Most experts rely on MRI to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma" — Greg Tiao (clinical) [Ep 11 · 3:13](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193)
- "Eovist is an MRI contrast agent taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging" — Greg Tiao (clinical) [Ep 11 · 3:13](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=193)
- "To establish a diagnosis of hepatoblastoma, four things are needed: history, abdominal imaging, AFP check, and liver biopsy" (clinical) [Ep 11 · 3:39](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219)
- "The most important intervention for survival is to achieve complete resection" (clinical) [Ep 11 · 3:39](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=219)
- "Aggressive resections include trisectionectomy, mesohepatectomy, resection with additional procedure in remnant liver, and liver transplantation" — Greg Tiao (clinical) [Ep 11 · 4:25](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=265)
- "Couinaud labeled liver segments in a counterclockwise fashion by injecting portal vessels, similar to how districts of Paris are labeled" (clinical) [Ep 11 · 4:50](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=290)
- "The right hepatic vein differentiates anterior and posterior sections of the right liver" — Greg Tiao (clinical) [Ep 11 · 5:41](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=341)
- "The right portal vein separates superior and inferior segments of the right liver" — Greg Tiao (clinical) [Ep 11 · 6:02](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=362)
- "The pre-text staging system classifies tumors based on the number of contiguous liver sections free of disease (minus four equals pre-text stage)" — Greg Tiao (clinical) [Ep 11 · 6:51](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411)
- "Pre-text 1 has three contiguous sections free of disease, pre-text 2 has two, pre-text 3 has one, and pre-text 4 has no free sections or diffuse tumor" — Greg Tiao (clinical) [Ep 11 · 6:51](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=411)
- "Pre-text 1 and 2 tumors with greater than 1 cm margin from middle hepatic vein and portal bifurcation should be considered for resection at diagnosis" (clinical) [Ep 11 · 8:01](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=481)
- "Pre-text 3 and 4 tumors represent a big game changer in practice that improved survival from less than 30% in the 1970s-80s to 80-90% today" — Greg Tiao (clinical) [Ep 11 · 8:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495)
- "Pre-text 3 tumors should generally be biopsied at diagnosis, started on neoadjuvant chemotherapy, then referred to transplant center or center with expertise in advanced liver resections" — Greg Tiao (clinical) [Ep 11 · 8:15](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=495)
- "Indications for transplant in pre-text 3 or 4 disease include unresectable disease, unsafe resection, or inadequate liver remnant" (clinical) [Ep 11 · 9:12](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=552)
- "It is important to consult a transplant center early for pre-text 3 and 4 tumors" — Greg Tiao (clinical) [Ep 11 · 9:35](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=575)
- "The PHITT (Pediatric Hepatic International Tumor Trial) is an ongoing multinational trial to identify high and low risk features for each pre-text stage" — Greg Tiao (clinical) [Ep 11 · 10:27](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627)
- "The PHITT study has been ongoing for three years" — Greg Tiao (clinical) [Ep 11 · 10:27](https://library.globalcastmd.com/watch/hepatoblastoma-with-dr-greg-tiao-5256?t=627)
- "In North America, the preferred approach for resectable renal tumors is primary nephrectomy and ureterectomy with lymph node sampling" — Peter Ehrlich (guideline) [Ep 10 · 6:23](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=383)
- "Preoperative chemotherapy is recommended if tumor extends into IVC beyond the infrahepatic vena cava" — Peter Ehrlich (guideline) [Ep 10 · 7:33](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=453)
- "Wilms tumors tend to push structures out of the way rather than growing around them, unlike neuroblastoma" — Peter Ehrlich (clinical) [Ep 10 · 4:16](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=256)
- "The claw sign on CT scan—normal kidney displaced into horseshoe pattern with tumor in the center—is classic for Wilms tumor" — Peter Ehrlich (clinical) [Ep 10 · 3:49](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=229)
- "Tumors between 13-15 centimeters or larger have higher risk of rupture and may warrant preoperative chemotherapy" — Peter Ehrlich (clinical) [Ep 10 · 14:33](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=873)
- "Core needle biopsy should include 10-20 cores to increase diagnostic accuracy; fine needle aspiration cannot diagnose anaplasia" — Peter Ehrlich (guideline) [Ep 10 · 18:03](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1083)
- "Stage 1 and 2 Wilms tumor patients receive only two-drug chemotherapy (vincristine and dactinomycin) for 19 weeks without radiation" — Peter Ehrlich (guideline) [Ep 10 · 20:36](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1236)
- "Stage 3 patients receive three-drug chemotherapy (adding doxorubicin) plus abdominal radiation" — Peter Ehrlich (guideline) [Ep 10 · 20:28](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1228)
- "A patient with lung metastases but stage 1-2 abdominal disease does not require abdominal radiation if primary tumor is completely resected with negative lymph nodes" — Peter Ehrlich (clinical) [Ep 10 · 24:15](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1455)
- "Approximately 40% of patients with pulmonary metastases achieve complete response by 6 weeks of chemotherapy and can avoid pulmonary radiation" — Peter Ehrlich (clinical) [Ep 10 · 26:44](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1604)
- "Fifteen percent of girls who receive pulmonary radiation for Wilms tumor develop breast cancer as a late effect" — Peter Ehrlich (epidemiological) [Ep 10 · 26:08](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1568)
- "The main late effects of Wilms tumor treatment are renal failure, second malignancies, pregnancy complications, hypertension, and cardiovascular disease, primarily from radiation and doxorubicin" — Peter Ehrlich (clinical) [Ep 10 · 23:37](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1417)
- "Loss of heterozygosity at both 1p and 16q occurs in 5-7% of patients and predicts 10% lower survival in stage 1-2 and 18% lower survival in stage 3-4" — Peter Ehrlich (clinical) [Ep 10 · 54:41](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3281)
- "Patients with tumors less than 550g, stage 1, favorable histology, and age under 2 years can be treated with surgery alone with greater than 95% survival" — Peter Ehrlich (clinical) [Ep 10 · 43:41](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2621)
- "IVC tumor thrombus extension is not a negative prognostic factor if completely resected" — Peter Ehrlich (clinical) [Ep 10 · 46:14](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2774)
- "Major complication rate for tumors extending beyond infrahepatic IVC operated upfront is 26-30% with documented mortality" — Peter Ehrlich (clinical) [Ep 10 · 48:49](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2929)
- "Bilateral Wilms tumor occurs in 8-10% of cases with historically lower survival: 61% event-free and 80% overall compared to 88% and 95% for unilateral disease" — Peter Ehrlich (epidemiological) [Ep 10 · 58:51](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3531)
- "Maximum tumor response to chemotherapy typically occurs by 12 weeks, with early response at 6 weeks predicting late response" — Peter Ehrlich (clinical) [Ep 10 · 59:37](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3577)
- "In bilateral Wilms tumor, there is discordant pathology between kidneys in up to 20% of cases" — Peter Ehrlich (clinical) [Ep 10 · 62:14](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3734)
- "SIOP protocols use preoperative chemotherapy for all patients with post-treatment staging based on blastemal predominance" — Peter Ehrlich (guideline) [Ep 10 · 30:31](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1831)
- "Lymph node positivity is the main prognostic factor in stage 3 disease" — Peter Ehrlich (clinical) [Ep 10 · 32:45](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=1965)
- "Acquired von Willebrand disease occurs in Wilms tumor patients and may rarely cause significant intraoperative bleeding" — Peter Ehrlich (clinical) [Ep 10 · 35:11](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2111)
- "Minimum lymph node sampling should be 5-6 nodes, though more than one may be better based on secondary evidence" — Peter Ehrlich (guideline) [Ep 10 · 39:49](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2389)
- "Taking a rim of adherent diaphragm or liver capsule to avoid tumor violation does not upstage the tumor if the tumor itself is not divided" — Peter Ehrlich (clinical) [Ep 10 · 42:31](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2551)
- "Positive surgical margins automatically make a tumor stage 3" — Peter Ehrlich (guideline) [Ep 10 · 41:24](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=2484)
- "Favorable histology Wilms tumor has three components: blastemal, stromal, and epithelial; tumors with only two components are still considered favorable" — Peter Ehrlich (clinical) [Ep 10 · 52:52](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3172)
- "In COG protocols, the amount of blastema in favorable histology tumors has never correlated with outcome" — Peter Ehrlich (clinical) [Ep 10 · 53:13](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3193)
- "Stage 2 patients receive vincristine and dactinomycin for 19 weeks; stage 3 patients receive DD4A regimen (adding doxorubicin) for 25 weeks" — Peter Ehrlich (guideline) [Ep 10 · 53:56](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3236)
- "Renal cell carcinoma is the second most common renal tumor in children, with no effective therapy for metastatic disease" — Peter Ehrlich (clinical) [Ep 10 · 56:51](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3411)
- "Rhabdoid tumors have terrible outcomes except for stage 1; most present at stage 3 or 4" — Peter Ehrlich (clinical) [Ep 10 · 57:27](https://library.globalcastmd.com/watch/wilms-tumor-audio-chapter-3487?t=3447)
- "Wilms tumor is the second most common intra-abdominal tumor in children and fifth most common tumor in children overall" — Rae Hanke (epidemiological) [Ep 8 · 0:00](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=0)
- "Approximately 75% of Wilms tumor cases occur in children younger than 5 years of age, with peak incidence at 2 to 3 years of age" — Andrew Davidoff (epidemiological) [Ep 8 · 0:28](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- "Survival for patients with Wilms tumor when considered as a whole is currently greater than 90%" — Andrew Davidoff (epidemiological) [Ep 8 · 0:28](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- "Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality" — Andrew Davidoff (epidemiological) [Ep 8 · 0:28](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=28)
- "Children with Wilms tumor typically present with an asymptomatic abdominal mass" — Andrew Davidoff (clinical) [Ep 8 · 1:20](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=80)
- "Associated signs and symptoms such as malaise, pain, microscopic or gross hematuria are found in only about 25% of children with Wilms tumor, as is hypertension" — Andrew Davidoff (clinical) [Ep 8 · 1:20](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=80)
- "The workup of a child with suspected Wilms tumor usually begins with ultrasound" — Andrew Davidoff (guideline) [Ep 8 · 1:46](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- "CT of the abdomen and pelvis is generally the definitive imaging study of choice for patients suspected of having a renal tumor based on ultrasound" — Andrew Davidoff (guideline) [Ep 8 · 1:46](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- "Intravascular tumor extension occurs in about 6% of Wilms tumor cases" — Andrew Davidoff (epidemiological) [Ep 8 · 1:46](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=106)
- "The most common site of metastatic spread of Wilms tumor is the lungs" — Andrew Davidoff (clinical) [Ep 8 · 2:44](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=164)
- "A chest CT should be included in the initial evaluation of a child suspected of having a Wilms tumor" — Andrew Davidoff (guideline) [Ep 8 · 2:44](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=164)
- "Localized Wilms tumors that are confined within the renal capsule are stage 1" — Andrew Davidoff (guideline) [Ep 8 · 2:59](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- "Wilms tumors that penetrate the renal capsule but are resected with negative margins are stage 2" — Andrew Davidoff (guideline) [Ep 8 · 2:59](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- "Stage 3 Wilms tumor includes circumstances such as biopsy or rupture (preoperative or intraoperative), positive resection margin or gross residual disease, lymph node involvement, or administration of preoperative chemotherapy" — Andrew Davidoff (guideline) [Ep 8 · 2:59](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- "Metastatic disease occurs in about 12% of Wilms tumor patients and is considered stage 4" — Andrew Davidoff (epidemiological) [Ep 8 · 2:59](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- "Patients with synchronous bilateral Wilms tumor are stage 5" — Andrew Davidoff (guideline) [Ep 8 · 2:59](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=179)
- "For unilateral tumors, upfront resection with regional lymph node sampling is currently the recommendation from the Children's Oncology Group" — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Most Wilms tumors are resectable at presentation because even large tumors rarely invade surrounding structures" — Andrew Davidoff (clinical) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Failure to perform upfront resection and instead administering neoadjuvant chemotherapy in COG results in classification as stage 3, mandating flank irradiation and doxorubicin, each associated with significant long-term toxicities" — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Treatment of favorable histology Wilms tumor stage 1 or 2 is limited to vincristine and actinomycin D" — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "In rare circumstances when tumor is stage 1, weighs less than 550 grams (tumor plus kidney), and patient is less than 2 years of age, no adjuvant chemotherapy is given" — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "The presence of nodal involvement is associated with an increased incidence of tumor relapse and a poorer prognosis" — Andrew Davidoff (clinical) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Lymph node sampling should be performed even in the absence of abnormal nodes on preoperative imaging or gross inspection during operative exploration, since these circumstances don't reliably predict lymph node negativity" — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Partial nephrectomy for patients with unilateral non-syndromic disease and laparoscopic nephrectomy are not currently standard of care and should generally only be performed in the context of a clinical trial" — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "Anaplastic histology is associated with significantly worse outcome and is treated with more intensive chemotherapy" — Andrew Davidoff (clinical) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "A distinction is made between focal and diffuse anaplasia when determining specific adjuvant therapy" — Andrew Davidoff (guideline) [Ep 8 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=246)
- "About 5% of children with Wilms tumor will present with synchronous bilateral disease or stage 5 disease" — Andrew Davidoff (epidemiological) [Ep 8 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "Patients with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs to shrink tumors prior to surgery and facilitate preservation of normal renal parenchyma due to increased risk of renal failure" — Andrew Davidoff (guideline) [Ep 8 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis" — Andrew Davidoff (guideline) [Ep 8 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "Biopsies of bilateral renal masses rarely detect anaplasia even when it does exist in the tumor mass" — Andrew Davidoff (clinical) [Ep 8 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "A biopsy in bilateral disease doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor" — Andrew Davidoff (guideline) [Ep 8 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "Bilateral nephron-sparing surgery should be considered in all patients with bilateral Wilms tumor and should be performed after either 6 or 12 weeks of neoadjuvant chemotherapy" — Andrew Davidoff (guideline) [Ep 8 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "Longer courses of preoperative chemotherapy than 6 or 12 weeks are definitely discouraged in bilateral Wilms tumor" — Andrew Davidoff (guideline) [Ep 8 · 6:53](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=413)
- "Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor" — Andrew Davidoff (clinical) [Ep 8 · 8:42](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- "Primary resection of tumors with extension above the level of the hepatic veins or into the atrium is associated with higher operative morbidity, so neoadjuvant chemotherapy is generally used in these circumstances" — Andrew Davidoff (guideline) [Ep 8 · 8:42](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- "Thrombus extending above the hepatic veins that persists after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove the full extent of disease" — Andrew Davidoff (guideline) [Ep 8 · 8:42](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=522)
- "About 12% of Wilms tumor patients will have evidence of hematogenous metastases at diagnosis with 80% of these being pulmonary metastases" — Andrew Davidoff (epidemiological) [Ep 8 · 9:58](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- "A new response-based approach is being used for patients with stage 4 disease in the Children's Oncology Group" — Andrew Davidoff (guideline) [Ep 8 · 9:58](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- "Stage 4 patients treated with three-drug chemotherapy who have radiographic disappearance of lung metastases or tissue confirmation that residual nodules don't contain viable tumor at week 6 are considered rapid responders and won't receive pulmonary irradiation" — Andrew Davidoff (guideline) [Ep 8 · 9:58](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=598)
- "Patients who don't have complete resolution of pulmonary nodules at 6 weeks are considered slow or incomplete responders, will be switched to more intensive chemotherapy regimen, and will receive whole lung irradiation" — Andrew Davidoff (guideline) [Ep 8 · 10:47](https://library.globalcastmd.com/watch/topics-in-10-wilms-tumor-1583?t=647)
- "Adrenal hemorrhage is the most common prenatal suprarenal mass, more common with history of fetal stress" — Daniel von Allmen (clinical) [Ep 9 · 2:00](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=120)
- "Familial neuroblastoma occurs in about 1% of patients" — Tony Sandler (epidemiological) [Ep 9 · 3:27](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=207)
- "The GetNucturne study showed that many prenatally diagnosed neuroblastomas can be safely observed without surgery" — Daniel von Allmen (clinical) [Ep 9 · 7:24](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=444)
- "Of 84 prenatally diagnosed cases observed in the GetNucturne study, 16 (about 20%) underwent resection, with 98% event-free survival and 100% overall survival" — Tony Sandler (clinical) [Ep 9 · 9:09](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=549)
- "Surveillance for prenatally diagnosed neuroblastoma is intensive in the first year with ultrasound and urine catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out" — Erika Newman (guideline) [Ep 9 · 9:58](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=598)
- "A case occurred where a prenatally diagnosed adrenal mass resolved but the child presented at age 3 with widely metastatic high-risk neuroblastoma" — Daniel von Allmen (clinical) [Ep 9 · 10:23](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=623)
- "Five centimeters is used as a size threshold for considering surgical resection of observed neuroblastoma" — Tony Sandler (opinion) [Ep 9 · 12:31](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=751)
- "A 50% increase in tumor volume or 50% increase in urine VMA or HVA prompts consideration of surgery" — Erika Newman (guideline) [Ep 9 · 13:20](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=800)
- "Lymph node status in neuroblastoma is not as important for changing therapy as it is in Wilms tumor" — Daniel von Allmen (clinical) [Ep 9 · 14:21](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=861)
- "Stage MS (formerly 4S) neuroblastoma with liver metastases can cause respiratory compromise from mass effect" — Erika Newman (clinical) [Ep 9 · 15:14](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=914)
- "Stage MS neuroblastoma can be treated with aggressive observation, chemotherapy, radiation, or emergent decompressive laparotomy if respiratory compromise occurs" — Erika Newman (clinical) [Ep 9 · 15:42](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=942)
- "Classic findings of stage MS include high urine catecholamines, blue blebs on skin, liver metastases, and adrenal mass" — Tony Sandler (clinical) [Ep 9 · 16:32](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=992)
- "NMYC amplification in stage MS changes classification from MS to M (stage 4) and makes it high-risk" — Erika Newman (clinical) [Ep 9 · 17:32](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1052)
- "Ten percent of neuroblastomas are not MIBG-avid and might be detected by PET scan" — Daniel von Allmen (clinical) [Ep 9 · 22:12](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1332)
- "Open biopsy allows adequate tissue for NMYC amplification, ALK mutation, and ploidy studies" — Tony Sandler (clinical) [Ep 9 · 23:50](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1430)
- "Approximately half of children's hospitals use percutaneous biopsy for suspected neuroblastoma" — Erika Newman (epidemiological) [Ep 9 · 26:56](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1616)
- "Percutaneous biopsy is equivalent to open biopsy for diagnosis, high versus low risk determination, and NMYC amplification, but falls short for determining 11q loss of heterozygosity" — Erika Newman (clinical) [Ep 9 · 28:10](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1690)
- "Optimizing percutaneous biopsy requires 10-12 cores, higher gauge needle, and pathologist performing frozen section to confirm viable tumor" — Erika Newman (clinical) [Ep 9 · 29:10](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1750)
- "Open biopsy patients had higher risk of blood transfusion, higher narcotic use, and more hospital admissions compared to percutaneous biopsy" — Erika Newman (clinical) [Ep 9 · 30:17](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1817)
- "NMYC amplification automatically makes neuroblastoma high-risk regardless of other factors" — Tony Sandler (clinical) [Ep 9 · 31:38](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1898)
- "Loss of heterozygosity at 11q is the most common segmental chromosomal alteration and can bump NMYC non-amplified patients to high or intermediate risk" — Erika Newman (clinical) [Ep 9 · 33:49](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2029)
- "Age cutoff for risk stratification is now 18 months rather than 12 months" — Tony Sandler (guideline) [Ep 9 · 35:25](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2125)
- "High-risk neuroblastoma patients require double lumen external central line for bone marrow transplant" — Erika Newman (clinical) [Ep 9 · 37:20](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2240)
- "Stem cell harvesting for high-risk neuroblastoma is usually after the second cycle of chemotherapy" — Tony Sandler (clinical) [Ep 9 · 45:31](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2731)
- "Optimal timing for surgical resection is after cycle 3-4 of induction chemotherapy" — Erika Newman (opinion) [Ep 9 · 41:49](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2509)
- "Tumor volume does not significantly decrease after cycle 2-3 of chemotherapy" — Daniel von Allmen (clinical) [Ep 9 · 43:17](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2597)
- "After 5-6 cycles of chemotherapy, tumors become more fibrotic and harder to resect" — Erika Newman (clinical) [Ep 9 · 43:17](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2597)
- "Goal of surgery is greater than 90% tumor resection based on COG study showing improved event-free survival" — Daniel von Allmen (clinical) [Ep 9 · 44:04](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2644)
- "European neuroblastoma group study of nearly 1000 cases showed >90% resection improved both event-free and overall survival" — Daniel von Allmen (clinical) [Ep 9 · 45:28](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2728)
- "About 70% of patients can achieve greater than 90% resection" — Daniel von Allmen (epidemiological) [Ep 9 · 45:28](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2728)
- "High-risk neuroblastoma responds well to chemotherapy due to high proliferative rate" — Tony Sandler (clinical) [Ep 9 · 45:31](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2731)
- "Recent German/European publication stated that amount of local disease resection does not make a difference in outcome" — Tony Sandler (clinical) [Ep 9 · 46:00](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2760)
- "Patients with high-risk neuroblastoma die of systemic metastatic disease, not local disease" — Tony Sandler (clinical) [Ep 9 · 46:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2800)
- "Good local control is achieved with combination of radiation and aggressive surgery" — Daniel von Allmen (clinical) [Ep 9 · 47:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2860)
- "There is zero correlation between surgeon's operative note description of resection extent and post-operative imaging findings" — Daniel von Allmen (clinical) [Ep 9 · 52:19](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3139)
- "Surgeons frequently overestimate the amount of tumor resection achieved" — Daniel von Allmen (opinion) [Ep 9 · 52:19](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3139)
- "Nephrectomy should be avoided in neuroblastoma surgery because it requires reduction of chemotherapy doses" — Tony Sandler (clinical) [Ep 9 · 53:13](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3193)
- "Monoclonal antibody against ganglioside GD2 improved two-year survival in high-risk neuroblastoma from 46% to 60%" — Tony Sandler (clinical) [Ep 9 · 53:44](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3224)
- "Checkpoint inhibitors have not been successful in neuroblastoma because it is not an immunogenic tumor" — Tony Sandler (clinical) [Ep 9 · 54:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3280)

## Changelog
- Aug 31: 25 doctors auto-found from episode dossiers
- Aug 30: 20 doctors auto-found from episode dossiers
- Aug 30: 16 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 29 doctors auto-found from episode dossiers
- Aug 29: 31 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 25 items, 16 dossiers, summaries for 4 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 18 items, 16 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 18 items, 16 dossiers, summaries for 3 audience(s)

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Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://library.globalcastmd.com/ai