Pediatric Doses

Wilm's Tumor

10.8 Gy



  • For severe hepatomegaly (4S) 1.5 Gy x 3 fractions can be considered.

Intermediate Risk

  • No role

High Risk

  • 21 Gy to primary regardless of extent or surgical resection
  • 21 Gy to metastatic disease that display persistent MIBG avidity on the pretransplant scans.
  • 10 Gy TBI for autologous transplantation.

Recurrent or refractory

  • Variable doses
  • 30 Gy in 2 Gy per fraction for high-functioning child
  • 7 Gy in single fraction for end-stage

Acute lymphoblastic leukemia

Cranial Prophylaxis

High-risk patients need CNS- prophylaxis

  • Cranial-spinal RT or Cranial RT + IT chemotherapy
  • Dose: 1800 cGy in 180 cGy per fraction


IRS IV – Current standard

4140 for microscopic disease (Group II)
5040 for gross disease (Group III)
4500 for Orbit


Radiation Doses

Clinical Group I II III IV
Embryonal (F) No XRT 3600 3600 (orbit)
4500 (non-orbit)
Dose to normal tissue tolerance
Embryonal (U) No XRT 3600 4140 (CR biopsy negative)
Dose to normal tissue tolerance
Alveolar 3600 N0-3600
5040 Dose to normal tissue tolerance

(U): unfavorable site
(F): Favorable site

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