De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor

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.

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APA	ELMALI A, Yuce Sari S, AKYÜZ C, Gultekin M, YALÇIN B, Aydin B, Varan A, Ekinci S, Gürkaynak M, Kutluk T, Yildiz F (2023). De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor. , 66 - 74. 10.5505/tjo.2022.3786
Chicago	ELMALI Ayşenur,Yuce Sari Sezin,AKYÜZ CANAN,Gultekin Melis,YALÇIN BILGEHAN,Aydin Burca,Varan Ali,Ekinci Saniye,Gürkaynak Murat,Kutluk Tezer,Yildiz Ferah De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor. (2023): 66 - 74. 10.5505/tjo.2022.3786
MLA	ELMALI Ayşenur,Yuce Sari Sezin,AKYÜZ CANAN,Gultekin Melis,YALÇIN BILGEHAN,Aydin Burca,Varan Ali,Ekinci Saniye,Gürkaynak Murat,Kutluk Tezer,Yildiz Ferah De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor. , 2023, ss.66 - 74. 10.5505/tjo.2022.3786
AMA	ELMALI A,Yuce Sari S,AKYÜZ C,Gultekin M,YALÇIN B,Aydin B,Varan A,Ekinci S,Gürkaynak M,Kutluk T,Yildiz F De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor. . 2023; 66 - 74. 10.5505/tjo.2022.3786
Vancouver	ELMALI A,Yuce Sari S,AKYÜZ C,Gultekin M,YALÇIN B,Aydin B,Varan A,Ekinci S,Gürkaynak M,Kutluk T,Yildiz F De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor. . 2023; 66 - 74. 10.5505/tjo.2022.3786
IEEE	ELMALI A,Yuce Sari S,AKYÜZ C,Gultekin M,YALÇIN B,Aydin B,Varan A,Ekinci S,Gürkaynak M,Kutluk T,Yildiz F "De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor." , ss.66 - 74, 2023. 10.5505/tjo.2022.3786
ISNAD	ELMALI, Ayşenur vd. "De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor". (2023), 66-74. https://doi.org/10.5505/tjo.2022.3786

APA	ELMALI A, Yuce Sari S, AKYÜZ C, Gultekin M, YALÇIN B, Aydin B, Varan A, Ekinci S, Gürkaynak M, Kutluk T, Yildiz F (2023). De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor. Türk Onkoloji Dergisi, 38(1), 66 - 74. 10.5505/tjo.2022.3786
Chicago	ELMALI Ayşenur,Yuce Sari Sezin,AKYÜZ CANAN,Gultekin Melis,YALÇIN BILGEHAN,Aydin Burca,Varan Ali,Ekinci Saniye,Gürkaynak Murat,Kutluk Tezer,Yildiz Ferah De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor. Türk Onkoloji Dergisi 38, no.1 (2023): 66 - 74. 10.5505/tjo.2022.3786
MLA	ELMALI Ayşenur,Yuce Sari Sezin,AKYÜZ CANAN,Gultekin Melis,YALÇIN BILGEHAN,Aydin Burca,Varan Ali,Ekinci Saniye,Gürkaynak Murat,Kutluk Tezer,Yildiz Ferah De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor. Türk Onkoloji Dergisi, vol.38, no.1, 2023, ss.66 - 74. 10.5505/tjo.2022.3786
AMA	ELMALI A,Yuce Sari S,AKYÜZ C,Gultekin M,YALÇIN B,Aydin B,Varan A,Ekinci S,Gürkaynak M,Kutluk T,Yildiz F De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor. Türk Onkoloji Dergisi. 2023; 38(1): 66 - 74. 10.5505/tjo.2022.3786
Vancouver	ELMALI A,Yuce Sari S,AKYÜZ C,Gultekin M,YALÇIN B,Aydin B,Varan A,Ekinci S,Gürkaynak M,Kutluk T,Yildiz F De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor. Türk Onkoloji Dergisi. 2023; 38(1): 66 - 74. 10.5505/tjo.2022.3786
IEEE	ELMALI A,Yuce Sari S,AKYÜZ C,Gultekin M,YALÇIN B,Aydin B,Varan A,Ekinci S,Gürkaynak M,Kutluk T,Yildiz F "De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor." Türk Onkoloji Dergisi, 38, ss.66 - 74, 2023. 10.5505/tjo.2022.3786
ISNAD	ELMALI, Ayşenur vd. "De-escalated Radiotherapy for Advanced Stage Wilms’ Tumor". Türk Onkoloji Dergisi 38/1 (2023), 66-74. https://doi.org/10.5505/tjo.2022.3786