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