From the Research
For Wilms tumor with intraoperative capsular rupture, intensified radiotherapy is recommended as part of the treatment protocol, with whole abdominal radiation therapy (WART) at a dose of 10-12 Gy, followed by a boost to the tumor bed of an additional 10-10.8 Gy, as supported by the most recent evidence 1. The treatment approach for Wilms tumor with intraoperative capsular rupture involves a combination of surgery, chemotherapy, and radiotherapy.
- The surgery aims to remove the tumor completely, while the chemotherapy targets any remaining cancer cells.
- The radiotherapy is crucial in eliminating potential microscopic disease throughout the peritoneal cavity and targeting the area at highest risk for recurrence. The radiation field for WART should extend from the diaphragm to the pelvic brim, while the boost field should encompass the tumor bed with a 1-2 cm margin, as indicated by studies on the management of complex Wilms tumors 2. Treatment planning should account for normal tissue constraints, particularly to the liver, remaining kidney, and spinal cord, to minimize the risk of long-term morbidity, as highlighted in the context of improving outcomes for children with Wilms tumor 3. Regular monitoring for acute side effects including nausea, diarrhea, and myelosuppression is essential during treatment, considering the intensified radiotherapy and chemotherapy regimen, which may be similar to those used in the treatment of relapsed Wilms tumor 4 or in the management of high-risk patients 5.