RT for gross Wilms tumor

[Pewl]

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Does anyone know of any good literature on the treatment of gross Wilms tumor with radiation? I've seen some case reports where they used 3000-4000cGy.

I know patients typically get post-op radiation to the tumor bed (in Europe sometimes pre-op), but I've read that in some cases of severe recurrence they just treat gross Wilms tumor with radiation.

 

[medgator]

I think there may be some info in the most recent NWTSG protocol (Study #5 I think?).

We had a patient who ended up recurring with wilms in the contralateral kidney a couple years after his initial Dx and Tx (including radical nephrectomy). I think we ended up going to the mid 40's after my attending contacted a few people down at St Jude's for some insight. He ended up receiving chemo after that.

I agree, there isn't a ton of data out there on this question.

 

[Brim]

Does anyone know of any good literature on the treatment of gross Wilms tumor with radiation? I've seen some case reports where they used 3000-4000cGy.

I know patients typically get post-op radiation to the tumor bed (in Europe sometimes pre-op), but I've read that in some cases of severe recurrence they just treat gross Wilms tumor with radiation.

What are the details of the specific case?

If this a recurrence? If so, is the recurrence in a previously irradiated field? What stage disease and histology was present initially and what treatment was given? How long was the interval between initial treatment and recurrence?

 

[Pewl]

It's a recurrence at an adjacent area paraspinal area. The tumor bed itself was previously irradiated to something like 10.8Gy. I'm not totally sure about the original stage, but there are currently some mets in the spleen. We're treating the area from T5-T8, including two vertebrae above and below the tumor (T3-T10ish) with about 20Gy. But, there isn't much literature for how much to give a gross tumor.

What are the details of the specific case?

If this a recurrence? If so, is the recurrence in a previously irradiated field? What stage disease and histology was present initially and what treatment was given? How long was the interval between initial treatment and recurrence?

 

[Palex80]

It all depends on the setting. If we are talking about a primary non-operable Wilms tumor or a postoperative residuum, then the radiation dose should be lower than in the case of a non-operated recurrent tumour.
On the other hand patients with recurrent tumours generally have had radiation as part of their first treatment usually, thus you should have tighter dose constraints to avoid long term sequlae.


The current active SIOP 2001 protocol in Europe calls for 25,2 Gy in case of intermediate-grade malignancy and 36 Gy in case of high-grade malignancy for macroscopic residual tumours in the primary treatment setting.

In the case of metachronic bilateral tumours current standard of care in Europe is chemotherapy with Vincristin and Actinomycin D followed by organ-perserving surgery. Radiation therapy is only indicated if operation is not possible or residual tumour is left behind with a maximum dose of 12 Gy.