Routine use of pelvic CT scans in Wilms tumor questioned

Omitting pelvic computed tomography (CT) scans from the routine surveillance of off-therapy patients with Wilms tumor could reduce radiation exposure without compromising relapse detection rates, researchers report.

In a retrospective study of 110 patients with Wilms tumor, only three patients developed pelvic relapse when they were followed up for a maximum of 12.5 years. All three patients were symptomatic when diagnosed and were considered at high risk for recurrence.

The authors also estimated the potential saving in absorbed dose if pelvic CT scans are not performed. Using anthropomorphic phantoms, they showed that omitting pelvic scans could reduce the effective dose by 30% to 45% in patients aged 15 years and under.

The authors believe the findings could impact on the controversial use of routine, off-therapy pelvic CT surveillance despite a low risk for pelvic recurrence and little evidence of an effect on tumor detection using this strategy.

"In keeping with 'As Low As Reasonably Achievable Radiation'… principles, we recommend reconsidering surveillance methodologies by omitting imaging of the pelvis altogether," say Sue Kaste (St Jude Children's Research Hospital, Memphis, Tennessee, USA) and colleagues.

Overall, 94% of patients in the study were alive at a median follow up after diagnosis of 6.5 years. Sixteen of the patients relapsed, most within the first year of diagnosis. Of the three patients with pelvic relapse, all were alive and without evidence of disease at their last follow up: 9.0, 4.6, and 4.2 years after relapse.

As well as being symptomatic, all three children had at least one previously defined risk factor for abdominal relapse, such as age greater than 48 months (n=2) and higher disease stage (stage III, n=2). Other identified high-risk features include a specimen weight in excess of 1000 g, tumor spillage, and unfavorable histology.

The authors suggest in Cancer that prospective national clinical trials could investigate the role of pelvic CT in such high-risk patients. However, they propose ultrasound or magnetic resonance imaging should be explored as an alternative to routine CT surveillance, to help limit childhood exposure to ionizing radiation.

Licensed from medwireNews with permission from Springer Healthcare Ltd. ©Springer Healthcare Ltd. All rights reserved. Neither of these parties endorse or recommend any commercial products, services, or equipment.

Kirsty Oswald

Written by

Kirsty Oswald

Kirsty has a B.Sc. in Human Sciences from University College London. After several years working as medical copywriter, she became a medical journalist and is now freelance. Kirsty also works part-time as an editor for a London-based charity. She is particularly interested in the social and cultural aspects of science.


Please use one of the following formats to cite this article in your essay, paper or report:

  • APA

    Oswald, Kirsty. (2018, August 23). Routine use of pelvic CT scans in Wilms tumor questioned. News-Medical. Retrieved on November 30, 2022 from

  • MLA

    Oswald, Kirsty. "Routine use of pelvic CT scans in Wilms tumor questioned". News-Medical. 30 November 2022. <>.

  • Chicago

    Oswald, Kirsty. "Routine use of pelvic CT scans in Wilms tumor questioned". News-Medical. (accessed November 30, 2022).

  • Harvard

    Oswald, Kirsty. 2018. Routine use of pelvic CT scans in Wilms tumor questioned. News-Medical, viewed 30 November 2022,


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
Post a new comment
You might also like...
CHG may be the most effective irrigation solution for use during surgical treatment of bone tumors