Harmonica consensus, controversies, and future directions in radiotherapy for pediatric Wilms tumors

Mary Frances McAleer*, Patrick Melchior, Jeannette Parkes, Luke Pater, Christian Rübe, Daniel Saunders, Arnold C. Paulino, Geert O. Janssens, John Kalapurakal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Radiotherapy (RT) is essential for multimodality treatment of pediatric renal tumors, particularly in higher-risk and metastatic disease. Despite decades of use, particularly for Wilms tumor, there remain controversies regarding RT indications, timing, dose, and targets. To align global management, we address these issues in this international HARMONIsation and CollAboration (HARMONICA) project. There are multiple knowledge gaps and opportunities for future research including: (1) utilization of advanced RT technologies, including intensity-modulated RT, proton beam therapy, combined with image-guided RT to reduce target volumes; (2) impact of molecular biomarkers including loss of heterozygosity at 1p, 16q, and 1q gain on RT indications; (3) mitigation of reproductive toxicity following RT; (4) promotion of RT late effects research; and (5) support to overcome challenges in RT utilization in low- and middle-income countries where 90% of the world's children reside. Here, we outline current status and future directions for RT in pediatric renal tumors.

Original languageEnglish (US)
JournalPediatric Blood and Cancer
StateAccepted/In press - 2022


  • Wilms tumor
  • pediatric renal tumors
  • radiotherapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology


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