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2 results

  • Chapter 17 - Solid Kidney Tumors

  • from Section 7 - Solid Tumors of the Kidney
  • Edited by Helen Liapis, Ludwig Maximilian University, Nephrology Center, Munich, Adjunct Professor and Washington University St Louis, Department of Pathology and Immunology, Retired Professor
  • Book:
    Pediatric Nephropathology & Childhood Kidney Tumors
    Published online:
    10 August 2023
    Print publication:
    09 March 2023, pp 299-340

  • Summary

    Paediatric renal tumours comprise a different spectrum of entities than occur in adults, reflecting the distinct chromatin state in the developing child. Nephroblastoma (Wilms tumour) with its histology of ‘nephrogenesis gone awry’ belongs to the primitive visceral cancers of childhood and is rare in adulthood, but makes up 90% of paediatric renal malignancies. Amongst paediatric renal neoplasms are some of the most aggressive and treatment-resistant cancers, including malignant rhabdoid tumour and renal medullary carcinoma. Recent molecular analysis has recognised that certain tumours arising within the kidney represent the visceral manifestation of a neoplasm that may alternatively arise within soft tissue (malignant rhabdoid tumour of kidney, congenital mesoblastic nephroma and peripheral primitive neuroectodermal tumour). Shared genetic driver mutations have been identified in what may appear to be very different tumours, but which have shared histology. This is true of the so-called BCOR family of tumours, whereby a BCOR rearrangement, or uncommonly instead the gene fusion YWHAE-NUTM2, occurs in clear cell sarcoma of kidney but also in high-grade endometrial stromal sarcoma and primitive mixed mesenchymal tumour of infancy. Dysregulation of chromatin is the oncogenic driver of some of these rare aggressive paediatric kidney cancers, including peripheral neuroectodermal tumour, clear cell sarcoma of kidney and malignant rhabdoid tumour.

  • Comparative dosimetric analysis of whole abdominal radiotherapy with VMAT versus 3D conformal in patients with Wilms tumour

  • Alejandro Olmos, Alejandro Rodriguez, Estefania Beltran, Onix Garay, Armando Felix, Mario Alberto Ponce, Maurico Salcedo, Teresa Apresa, Lorena Lio, Martha Guzman, Fatima Chilaca
  • Journal:
    Journal of Radiotherapy in Practice / Volume 18 / Issue 3 / September 2019
    Published online by Cambridge University Press:
    15 February 2019, pp. 301-303
  • Introduction

    In this study, we undertake a dosimetric comparison of whole abdominal treatment plans of patients diagnosed with stage 3 Wilms tumour, to assess the benefits of treating these patients with volumetric arch therapy (VMAT) versus 3D conformal radiotherapy.

    Material and methods

    A retrospective study was undertaken on 23 patients receiving either VMAT or 3D conformal radiotherapy during 2013–2017. A dosimetric comparison was undertaken for both techniques, measuring planning target volume (PTV), conformity index (CI), homogeneity index (HI) and organs at risk (OAR).

    Results

    The dosimetric parameters for the PTV dose in the VMAT and 3D conformal technique showed no statistical difference (1,289·17 cGy versus 1,357·13 cGy, respectively, p=0·404). However, the VMAT technique had a better CI (1·04 VMAT versus 1·26 3D, p=0·004), and there was little difference in the HI (1·13 VMAT versus 1·15 3D, p=0·1606). In the statistical analysis, the decrease in dose to OAR for the VMAT technique is statistically significant for doses to lung and kidney (p=0·011 and p=0·002, respectively). Between the two techniques, there was no statistical significance in dose difference to the other OAR.

    Conclusion

    This work proposes using the VMAT technique in whole abdominal irradiation to improve conformity, without affecting the quality of the PTV coverage, when compared with the 3D conformal technique. In addition, VMAT reduces the doses to OAR such as the remaining kidney and lungs that are important to preserve to reduce the probability of radiation toxicity in these patients.