When are increased flank doses beneficial in Stage III Wilms tumor?

The current standard of care in North America for radiotherapy dose in the treatment of Wilms tumor (WT) has been established by the National Wilms Tumor Study (NWTS)-3. This study randomized Stage III favorable histology patients to 1000 cGy vs. 2000 cGy as well as 2 drugs (actinomycin D and vincri...

I believe this dose was determined by the AREN0321 protocol.

Typical indications for increased flank doses to 19.8 Gy in 11 fx include:

• Patients if ≥16 years of age
• Stage III tumors with diffuse anaplasia
• Stage I-III Rhabdoid tumor of the kidney if age > 1-year-old.

Note that a 10.8 Gy boost is added...