The SIOP-Renal Tumour Study Group consensus statement on flank target volume delineation for highly conformal radiotherapy

Janssens, Geert O.; Melchior, Patrick; Mul, Joeri; Saunders, Daniel; Bolle, Stéphanie; Cameron, Alison; Claude, L.; Gurtner, Kristin; Ven, Kees P. van de; Grotel, Martine van; Harrabi, Semi; Lassen‐Ramshad, Yasmin; Lavan, Naomi; Magelssen, Henriette; Muracciole, Xavier; Boterberg, Tom; Mandeville, Henry; Godziński, Jan; Graf, Norbert; Heuvel‐Eibrink, Marry M. van den; Rübe, Christian

doi:10.1016/s2352-4642(20)30183-8

Cited by 27 publications

(39 citation statements)

References 25 publications

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“…To our knowledge, this is the first cohort of pediatric patients with a renal tumor that describes the locoregional outcome of highly conformal flank irradiation using new target volumes adjusted for postoperative organ shifts and optimized by the use of surgical clips and 4D-CT scans [17,21]. After a median followup of 3.1 years, two patients developed a locoregional relapse resulting in a 2-year LCR of 94%, which is in line with the reported number of locoregional events observed in patients with stage III WT treated by the use of a conventional technique within the SIOP-2001 and AREN0532 studies [4,25].…”

Section: Discussionmentioning

confidence: 99%

“…For target volume delineation, the lateral clip was used to determine the lateral tumor extension, while the superior clip was used to capture the intra-fraction motion of the tumor bed, as described in a previous report [21]. Gross Tumor Volumes (GTV) and Clinical Target Volumes (CTV) were corrected for the postoperative changes in anatomy, in line with the SIOP-RSTG consensus statement on highly conformal flank target volume delineation [17]. An Internal Target Volume (ITV) margin, defined as the maximum intra-fraction motion registered by the 4D-CTscan, was used to expand the CTV.…”

Section: Highly Conformal Flank Irradiationmentioning

confidence: 99%

“…For decades, the use of two opposing Anterior-Posterior/Poster ior-Anterior (AP/PA) photon beams has been considered standard of care for flank RT, using the tumor volume before surgery as the target volume [16]. In the past years, the SIOP-RTSG has developed a new flank target volume definition that adjusts for the postoperative changes and intra-fraction motion [17]. Combined with modern RT techniques, this new target volume allows highly conformal dose distributions that reduce the risk of late toxicity to the surrounding healthy tissue [18][19][20].…”

mentioning

confidence: 99%

“…Since November 2014, pediatric renal cancer care in The Netherlands has been centralized and all patients eligible for flank irradiation received Volumetric-Modulated Arc Therapy (VMAT) on highly conformal flank target volumes [17]. The aim of the current report was to describe the locoregional control and outcome after highly conformal flank irradiation and to evaluate whether recurrences might have been avoided by conventional RT by performing an in-depth dose reconstruction.…”

mentioning

confidence: 99%

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Locoregional control using highly conformal flank target volumes and volumetric-modulated arc therapy in pediatric renal tumors: Results from the Dutch national cohort

Mul

Grotel

Seravalli

et al. 2021

Radiotherapy and Oncology

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Background and purpose: In pediatric renal tumors, conventional two opposing photon beams have been used to cover the postoperative flank target volume for decades. This single center study describes the locoregional outcome using highly conformal flank target volumes adjusted for postoperative changes and intra-fraction motion combined with Volumetric-Modulated Arc Therapy (VMAT). Materials and methods: Between 01-2015 and 12-2019, 36/161 newly diagnosed patients with renal tumors underwent flank only irradiation (n = 30) or flank + whole lung irradiation (n = 6) using highly conformal target volumes in line with the SIOP-RTSG consensus statement. VMAT consisted of full-arc 10MV photon beams optimized for constraints of the organs at risk. In case of locoregional relapses, image co-registration and dose reconstruction was performed. Each relapse was classified as either 'infield' (V95% relapse : 99.0%), 'marginal' (V95% relapse : 20.0-98.9%) or 'outfield' (V95% relapse : 0-19.9%). Results: At a median follow-up from diagnosis of 3.1 years (range:0.4-5.7), the estimated 2-year Locoregional Control Rate, Disease-Free Interval and Overall Survival were 94%, 91% and 94%, respectively. Locoregional relapse was observed in two patients. One patient had a combined tumor bed and regional recurrence, classified as infield (V95% relapse : 100%) and outfield (V95% relapse : 1.2%). The second patient had a regional relapse in the inferior vena cava classified as marginal recurrence (V95% relapse : 93%). Relapses would not have been adequately covered by conventional beams. Conclusions: This single center analysis provides encouraging evidence that excellent locoregional control can be obtained by using highly conformal flank target volumes with VMAT in pediatric renal tumors. The safety of this approach will be validated in a prospective multicenter study.

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Section: Discussionmentioning

confidence: 99%

Section: Highly Conformal Flank Irradiationmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Locoregional control using highly conformal flank target volumes and volumetric-modulated arc therapy in pediatric renal tumors: Results from the Dutch national cohort

Mul

Grotel

Seravalli

et al. 2021

Radiotherapy and Oncology

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“…Radiotherapy (IGRT) techniques that allow high-precision dose delivery to complex target volumes. Prompted by this development, radiation oncologists affiliated to the SIOP-RTSG reached consensus on a highly-conformal target volume definition for flank irradiation: it was hypothesized that intraperitoneal tumor recurrence is unlikely in patients without major tumor rupture [7]. This was based on the fact that renal tumors are covered by a peritoneal lining and push aside, rather than invade, the intraperitoneal organs and abdominal wall.…”

Section: Discussionmentioning

confidence: 99%

The contribution of surgical clips for optimizing highly-conformal image-guided flank irradiation in pediatric renal tumors: A single center experience

Mul

Ven

Seravalli

et al. 2021

Radiotherapy and Oncology

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White paper: Oncofertility in pediatric patients with Wilms tumor

Perk

Cost

Bos

et al. 2022

Intl Journal of Cancer

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The survival of childhood Wilms tumor is currently around 90%, with many survivors reaching reproductive age. Chemotherapy and radiotherapy are established risk factors for gonadal damage and are used in both COG and SIOP Wilms tumor treatment protocols. The risk of infertility in Wilms tumor patients is low but increases with intensification of treatment including the use of alkylating agents, whole abdominal radiation or radiotherapy to the pelvis. Both COG and SIOP protocols aim to limit the use of gonadotoxic treatment, but unfortunately this cannot be avoided in all patients. Infertility is considered one of the most important late effects of childhood cancer treatment by patients and their families. Thus, timely discussion of gonadal damage risk and fertility preservation options is important. Additionally, irrespective of the choice for preservation, consultation with a fertility preservation (FP) team is associated with decreased patient and family regret and better quality of life. Current guidelines recommend early discussion of the impact of therapy on potential fertility. Since most patients with Wilms tumors are prepubertal, potential FP methods for this group are still considered experimental. There are no proven methods for FP for prepubertal males (testicular biopsy for cryopreservation is experimental), and there is just a single option for prepubertal females (ovarian tissue cryopreservation), posing both technical and ethical challenges. Identification of genetic markers of susceptibility to gonadotoxic therapy may help to stratify patient risk of gonadal damage and identify patients most likely to benefit from FP methods.

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The SIOP-Renal Tumour Study Group consensus statement on flank target volume delineation for highly conformal radiotherapy

Cited by 27 publications

References 25 publications

Locoregional control using highly conformal flank target volumes and volumetric-modulated arc therapy in pediatric renal tumors: Results from the Dutch national cohort

Locoregional control using highly conformal flank target volumes and volumetric-modulated arc therapy in pediatric renal tumors: Results from the Dutch national cohort

The contribution of surgical clips for optimizing highly-conformal image-guided flank irradiation in pediatric renal tumors: A single center experience

White paper: Oncofertility in pediatric patients with Wilms tumor

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