Which of the following approaches is considered standard care for most Wilms’ tumor patients in the United States today?

c. Primary surgical resection followed by chemotherapy

The standard of care for Wilms’ tumor patients in the United States is initial surgical resection. Exceptions to this rule include extensive intracaval tumors which require cardiopulmonary bypass for extraction, obviously unresectable tumors with documented invasion of contiguous structures, and possibly bilateral tumors, especially if it is unclear which side is most heavily involved. All resectable Wilms’ tumor patients receive postoperative chemotherapy with the possible exception of Stage 1 favorable histology patients who are younger than 24 months of age at diagnosis and have tumors less than 250 grams in weight at resection. Chemotherapy followed by surgical resection is practiced in Europe with roughly equal outcomes to those in the United States but this approach has the disadvantage of changing the surgical and pathologic staging which are the basis for the National Wilms’ Tumor Studies and the cornerstone of treatment in the United States. Needle biopsy has a very limited role for unusual presentations of Wilms’ tumor as the diagnosis is generally apparent with modern imaging techniques. Radiation therapy is not a primary mode of therapy for Wilms’ tumor under contemporary National Wilms’ Tumor treatment protocols.