Radiotherapy plays a key role as an adjuvant treatment in pediatric Wilm's tumor, improving both survival and quality of life. The success of radiotherapy depends on the precise delivery of radiation dose to the tumor while sparing radiosensitive structures in the vicinity of the tumor. Pediatric patients pose unique challenges in achieving accurate radiotherapy delivery due to their inability to understand instructions and the high radiosensitivity of their tissues. Thus, it is important to determine the optimum geometric verification strategy that will ensure accurate delivery of the prescribed target as specified in the patient's treatment plan. To evaluate the performance of an offline geometric correction strategy in ensuring accuracy and reproducibility during radiotherapy delivery in Wilm's tumor patients. The extended no-action level offline correction strategy was applied in the radiotherapy delivery of 45 Wilm's tumor patients. Gross errors from the first three fractions were used to calculate the mean errors which were then applied as offline correction factors. Mean errors among different groups were compared using a two-way analysis of variance (ANOVA) and Dunnett's pairwise comparisons. All statistical analyses and data visualization were performed using GraphPad Prism version 7 (Insight Partners, GraphPad Holdings, LLC). A total of 45 patients were included in the study. In all three orthogonal directions, the recorded gross errors were significantly lower after the application of the systematic error corrections. Random errors were significantly larger in the longitudinal direction compared to lateral (mean difference = 0.28, p = 0.036) and vertical directions (mean difference = 0.37 cm, p = 0.003). Patients' age was a significant predictor of random errors whereby the magnitude of random error decreased with increasing age. This study shows that the offline correction strategy used is effective in ensuring the accuracy of radiotherapy delivery in pediatric Wilm's tumor patients.

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