1. Radiation therapy plays an important role in the treatment of Wilms tumor, especially for advanced or high-risk cases. 2. It is used preoperatively, postoperatively, and for metastatic disease to reduce the risk of recurrence. 3. The indications and techniques for radiation therapy depend on factors like tumor stage, histology, response to chemotherapy, and whether metastases are present. Precise radiation treatment planning is required to effectively target tumors while sparing healthy tissues.

10. RT Dose CCSK Diffuse anaplasia Focal anaplasia Stage I-III FLANK RT : 10.8Gy , 180cGy/fx FH Stage III RTK Stage I-III FLANK RT : 19.8Gy (Infants -10.8Gy), 180cGy/fx Diffuse anaplasia Stage III

11. + 10Gy Renal Shielding / Limit the dose to remaining kidney <14.4Gy Residual Boost 19.8Gy in 11# Unresected Lymph nodes 12Gy WLI in 8# FH / UH Lung (mets.) 19.8Gy WLivI in 11# Liver (mets.) 10Gy, 150cGy/Fx FH Whole Abdomen RT 25.2 Gy in 14# Bone (mets.) 36.6Gy WB in 17# Or 21.6Gy WB + 10.8Gy IMRT /SRST Boost Brain (mets.)

13. Treatment Fields - Flank

21. Long-term results of NWTS-3 and -4

22. Results – 4yrs – FH (NWTS 5) 93.9% 85.3% III Lung Mets, Pulm RT 74.6% IV 92% 83% II 98% 92% I EFS OS RFS Stage

25. Thank You