Radiotherapy
Radiotherapy in nephroblastoma has become less frequent in both the USA and Europe with the release of the NWTSG, SIOP and other studies.
In the USA:
- Flank radiotherapy is prescribed when patients have stage III disease with no peritoneal contamination or pre-surgical biopsy
- It is also prescribed when an unfavourable histology is present
- Whole abdominal radiotherapy is prescribed when patients have stage III disease due to peritoneal contamination
- Radiotherapy to the lungs is prescribed where tumours have failed to respond to chemotherapy within 6 weeks of commencement
- Radiotherapy to the brain or other metastases follows a similar procedure
The recommended dose varies according to site. In general, fractions are 1.8 Gy except for whole lung/whole abdominal radiotherapy where they are 1.5 Gy.
- 10.8 Gy in 6 x 1.8 Gy fractions to the flank
- Add a 10 Gy boost to macroscopic residual disease
- 10.5 Gy in 7 x 1.5 Gy fractions to the whole abdomen
- 12 Gy in 8 x 1.5 Gy fractions to the whole lung
- 30.6 Gy in 17 x 1.8 Gy fractions for brain metastases
- Can be performed as 2 phase technique; 21.6 Gy to whole brain and 9 Gy boost to tumour volume
- 19.8 Gy in 11 x 1.8 Gy fractions for liver metastases
- 25.2 Gy in 15 x 1.8 Gy fractions for bone metastases
In Europe:
- Flank radiotherapy is only offered in high risk stage II/III patients and intermediate risk stage III patients (or in stage IV patients with these abdominal stages)
- Whole abdominal radiotherapy is offered when peritoneal contamination has occured (uncommon with SIOP protocols)
- Lung, liver and brain radiotherapy is offered for stage IV patients when tumour persists or if high risk pathology is present
Doses are different to USA protocols:
- Flank radiotherapy involves 14.4 Gy in