ABSTRACT
Favorable histology Wilms’ tumors receive radiation therapy when there is gross residual tumor at the primary site following resection, positive surgical margins, peritoneal tumor nodules, regional lymph node involvement, or spillage of tumor cells through a ruptured capsule into the flank or peritoneal cavity (stage III disease) or distant metastasis (stage IV disease) . All high-risk renal cancers regardless of stage or completeness of resection receive irradiation to at least the preoperative tumor volume . Lymph node involvement or a localized spill of tumor cells is treated with irradiation of the entire ipsilateral flank . If there has been diffuse dissemination of tumor cells throughout the peritoneum, either by seeding or tumor rupture, the whole abdomen is irradiated (WAI) . A dose of 10 .5 to 10 .8 Gy is given for microscopic residual tumor in the abdomen or tumor spillage for either newly diagnosed or recurrent Wilms’ tumor . Gross residual tumor at the primary site, in the peritoneum or liver receives 21 .6 to 30 .6 Gy . In the unusual circumstance of either stage III diffuse anaplasia or a patient older than 16 years of age, the dose for microscopic residual is raised to 19 .8 Gy .
