Postoperative radiation therapy in Wilms tumor is indicated when which criteria are met?

Postoperative radiation therapy in Wilms tumor is indicated when which criteria are met?

• A. Extension beyond renal capsule, pulmonary metastases, or large tumor
• B. Age over 5 years
• C. Negative urine cytology
• D. Bilateral renal involvement

Answer: (A)

In Wilms tumor, radiation after surgery is guided by the risk of residual cancer. If the tumor extends beyond the renal capsule, there’s a higher chance cancer cells remain in the surrounding tissues or regional lymphatics, so postoperative radiation helps sterilize those cells and reduce local recurrence. Pulmonary metastases indicate distant spread, and chest irradiation is needed to address metastatic deposits in the lungs. A very large tumor also carries a greater risk of microscopic leftover disease, so adjuvant radiation is used to improve overall local control in bulky cases. Age, negative urine cytology, or bilateral involvement do not by themselves mandate postoperative radiation; management in bilateral disease focuses on preserving renal function while treating with chemotherapy and targeted therapy as appropriate.

In Wilms tumor, radiation after surgery is guided by the risk of residual cancer. If the tumor extends beyond the renal capsule, there’s a higher chance cancer cells remain in the surrounding tissues or regional lymphatics, so postoperative radiation helps sterilize those cells and reduce local recurrence. Pulmonary metastases indicate distant spread, and chest irradiation is needed to address metastatic deposits in the lungs. A very large tumor also carries a greater risk of microscopic leftover disease, so adjuvant radiation is used to improve overall local control in bulky cases. Age, negative urine cytology, or bilateral involvement do not by themselves mandate postoperative radiation; management in bilateral disease focuses on preserving renal function while treating with chemotherapy and targeted therapy as appropriate.