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Would you give whole-abdomen RT for preoperative rupture of favorable histology Wilm's Tumor treated with induction chemotherapy followed by GTR?
The patient initially presented with an large renal tumor encasing the IVC and abutting the abdominal aorta. Given this, the patient received induction chemotherapy and went on to receive a GTR with positive pelvic and PA nodes.
Initial imaging was concerning for pre-operative rupture, and this was confirmed by the surgeon at the time of resection (poorly defined margin in area concerning for rupture) without gross spillage at the time of surgery. Final pathology demonstrated favorable histology Wilms without anaplasia or LOH, and +LN. No gross disease was noted on post-op CT.
Given the concern for pre-operative rupture would you perform WART vs RT to the flank+PA nodes?
Is 10.5 Gy/7fx sufficient? Would you deliver a flank boost?
Answer from: Radiation Oncologist at Academic Institution
The short answer is yes, if you saw free fluid in the pelvis pre-treatment, and there were other signs of pre-operative rupture at the time of resection following chemotherapy, then WART should be considered.Given that the patient had positive LN at diagnosis, I would review the path report to see i...
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