Nephroblastoma is the most common renal malignancy of childhood (6% of all paediatric cancers). In the modern era it is commonly cured with a combination of surgical, radiotherapy and chemotherapy techniques.
The approach is different for COG and SIOP.
For COG, and favourable histology, radiotherapy is limited for patients with stage III or IV disease:
- Flank Radiotherapy: For patients with positive margins or lymph node metastases
- 10.8 Gy in 6 fractions of 1.8 Gy
- If gross residual disease boost to 21.6 Gy in 12 fractions
- Whole Abdominal Radiotherapy: For patients with tumour spillage intraoperatively
- 10.5 Gy in 7 fractions of 1.5 Gy
- Boost gross disease as above
- Whole Lung Radiotherapy: For patients with lung metastases that incompletely respond to radiotherapy
- 12 Gy in 8 fractions of 1.5 Gy
- Whole Liver Radiotherapy: For patients with liver metastases that do not completely respond to radiotherapy
- 19.8 Gy in 11 fractions
- Whole Brain Radiotherapy: For patients with brain metastases
- 21.6-30.6 Gy if younger or older than 16
- Bone radiotherapy: For patients with bone metastases that do not completely respond to chemotherapy.
- 25.2-30.6 Gy in younger or older than 16
For patients with anaplastic histology:
- Flank Radiotherapy to 21.6 Gy for stages II+
For patients with clear cell sarcoma:
- Flank radiotherapy to 21.6 Gy for all stages