**3. Mitigation strategies and surveillance guidelines**

The use of two parallel-opposed anterior-posterior (AP) and posterior-anterior (PA) fields has been the conventional approach for RT of WT for many decades. Modern RT techniques such as cardiac sparing whole lung intensity-modulated radiation therapy (IMRT) techniques haves been shown statistically significant reduction of cardiac and myocardial RT doses compared to standard AP-PA WLI techniques in a prospective clinical trial [12]. Another report showed that the mean cardiac dose was significantly higher when the lung and abdomen RT fields were treated sequentially compared to when they were treated concurrently [18]. All current and future COG protocols will permit the use of cardiac sparing whole lung IMRT with central quality assurance review, concurrent treatment of lung and abdomen RT fields and IMRT/proton therapy for the treatment of flank and whole abdomen.

The COG LTFU guidelines, version 5.0, provide extensive recommendations for the appropriate surveillance of childhood cancer survivors for common RT-induced toxicities observed in WT survivors (http://survivorshipguidelines.org). A summary of these guidelines is provided in **Table 1**.


### **Table 1.**

*The Children's oncology group long-term follow-up guidelines recommendations (summary) for surveillance of childhood cancer survivors exposed to anthracycline therapy (http://survivorshipguidelines.org).*
