Nonexcisional biopsy standard for orbital tumors
Wide excision if feasible; routine sampling of clinically; uninvolved nodes not indicated
Inguinal incision, orchiectomy, resection of entire spermatic cord. Formal dissection of ipsilateral retroperitoneal lymph nodes not indicated in ages <10 years. Systematic sampling of bilateral high and low infrarenal and bilateral iliac nodes is recommended (although role in subsequent management is unclear). Positive inguinal nodes are considered distant spread (stage IV).
Complete surgical excision rarely possible initially. Second-look operation at week 9, with radiation therapy based on results.
Wide resection rarely feasible. Cervical lymph node biopsy only if clinically suspicious nodes. Begin radiation therapy at day 0 for limited intracranial extension, base of skull invasion, bone erosion, or cranial neuropathy. Begin at week 9 if no intracranial extension. No whole-brain radiation therapy (tumor plus 2-cm margin).
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