Comparison of different planning techniques and out-of-field doses in bilateral lung irradiation for Wilms' tumor metastatic to the lung

We aimed to compare different planning techniques and thermo-luminescence dosimeters (TLD) results for bilateral lung irradiation. Different plans were made for bilateral lung irradiation of a pediatric patient. Target volume coverage, critical organ doses, MU and out-of-field dose were compared. Right and left lung volumes following receipt of 12 Gy for anteroposterior-posteroanterior (AP-PA), feKT, intensity-modulated radiotherapy (IMRT), and feIMRT were 82%, 88%, 82%, 83% and 80%, 85%, 75%, 80%, respectively. The maximum doses were found as 1319, 1317, 1618 and 1560 cGy. The volumes of the heart that received 1000 cGy were determined as 66%, 49%, 27%, and 29%, respectively. The TLD readings of the brain and thyroid at the feIMRT were higher than the others. In two IMRT plans, results reduced the heart dose. We achieved better lung coverage with feKT. When selecting the most appropriate treatment modality, clinical assessment is very important in pediatric cases. The late side effects and risks of secondary malignancy should not be ignored.