From
Dr. Nelson G. Rosen
Wilms tumor management: comparing COG and SIOP treatment approaches
With Dr. Bargaba Mulaudi · hosted by Lizzy Lee, PA-C
Chapter 1 of 4
COG vs SIOP
Case presentation and international treatment variation
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Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
European colleagues would offer chemotherapy without biopsy for Wilms tumor, while North American/COG sites would perform resection and diagnosis first.
Doxorubicin should be added when there is loss of heterozygosity at 1P and 16Q because that shows higher recurrence.
For surgeons, there will be more waiting for biology results before determining if chemotherapy is needed, affecting timing of port placement.
It is not accurate to tell families that children under 2 years of age with tumors under 550g will not need chemotherapy, because biology studies may require adding chemotherapy if loss of heterozygosity at 1P16Q is present.
Even in stage 1 favorable histology, if loss of heterozygosity is present, chemotherapy is still added.
The case tumor was stage 2 Wilms tumor because it involves the renal sinus and lymphovascular spaces, with overall favorable histology.
Loss of heterozygosity is the loss of genetic diversity in tumor cells and in Wilms tumor can indicate more aggressive disease.
Gain of 1Q refers to an extra copy of a section of chromosome 1, which is linked to worse outcomes in some cancers.
Children's Oncology Group updates state that adverse biologic factors are associated with worse prognosis in stage 2 patients, but not in stage 1 favorable histology Wilms tumor patients.
The North American Children's Oncology Group approach often involves immediate surgery for Wilms tumor.
The European Society of Pediatric Oncology approach typically starts with chemotherapy before surgery for Wilms tumor.
Genetic markers like loss of heterozygosity at specific chromosomes can indicate higher risk of cancer recurrence and guide decisions about adding chemotherapy.