De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor

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Elmali A., YÜCE SARI S., AKYÜZ C., GÜLTEKİN M., YALÇIN B., Aydin B., ...More

Turk Onkoloji Dergisi, vol.38, no.1, pp.66-74, 2023 (ESCI) identifier

  • Publication Type: Article / Article
  • Volume: 38 Issue: 1
  • Publication Date: 2023
  • Doi Number: 10.5505/tjo.2022.3786
  • Journal Name: Turk Onkoloji Dergisi
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, Academic Search Premier, CINAHL, EMBASE
  • Page Numbers: pp.66-74
  • Keywords: De-escalated treatment, radiotherapy, Wilms’ tumor
  • Hacettepe University Affiliated: Yes


OBJECTIVE Survival rates have dramatically improved in Wilms’ tumor (WT) with multimodal treatment. Herein, we aimed to compare the efficacy of 9–10.8 Gy flank irradiation or whole abdominal irradiation (WAI) in patients with WT treated in a single tertiary treatment center. METHODS This study includes 42 patients with a unilateral or bilateral WT with a local Stage III disease who received a low-dose (10.8 Gy) or lower-dose (9 Gy) flank radiotherapy (RT) or whole abdominal irradiation between 1998 and 2018. Patients had undergone either upfront surgery followed by adjuvant chemotherapy (CXT) or neoadjuvant CXT followed by surgery. Patients with lung metastasis without a complete response to CXT also received whole lung irradiation (WLI) of 9–12 Gy. RESULTS The disease was staged as III in 22, IV in 12, and V in nine patients, respectively. After a median follow-up of 75 months, the 2-and 5-year overall survival, locoregional relapse-free survival, and distant metastasisfree survival rate was 92% and 79%, 87% and 76%, and 75% and 69%, respectively. None of these survival rates were significantly different among 9 Gy and 10.8 Gy doses. Among patients receiving WLI, the lung relapse rate was also similar between <12 Gy and 12 Gy of irradiation. Late toxicity was observed in 4 (10%) patients as scoliosis, cardiac dysfunction, renal injury with hypertension, and short stature in each. CONCLUSION De-escalated RT of 9 Gy to the flank or abdomen does not compromise oncologic outcomes in patients with a local Stage III WT.