Radiotherapy to the surviving kidney after unilateral nephrectomy in bilateral Wilms' tumour

Despite an improving overall survival rate for children with Wilms' tumour, four out of seven patients with bilateral tumours died in the period from 1952 to 1960 and five out of eight died in the period from 1971 to 1989, at St Bartholomew's Hospital and the Hospital for Sick Children. More aggressive chemotherapy with both adriamycin and actinomycin D and concern over young age being predisposed to late radiation morbidity prompted us to keep radiotherapy dose prescriptions to the surviving kidney below the quoted renal radiation tolerance dose equivalent. In three long-term survivors treated with daily fractions up to 167 cGy and total doses of 1000-1200 cGy, we have found renal function and growth to be within the "normal" range at follow-up and the patients to be normotensive 6-8 years later. As four of the eight patients reported here died from local disease progression within the kidney (albeit despite slightly larger dose prescriptions), we discuss the potential for larger total doses to be delivered in this situation.