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    This document summarizes dose and volume parameters associated with radiation-induced toxicity for various organs. It provides the estimated rate of adverse effects like necrosis, neuropathy or dysfunction for organs like brain, spinal cord, lungs and liver at different dose levels. For example, the risk of symptomatic pneumonitis in the lungs is estimated at 5% if the mean lung dose is 7Gy, but rises to 40% if the mean dose is 27Gy. The table aims to guide safe dose constraints in radiation therapy planning by organ to minimize complications.

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    Quante C

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    This document summarizes dose and volume parameters associated with radiation-induced toxicity for various organs. It provides the estimated rate of adverse effects like necrosis, neuropathy or dysfunction for organs like brain, spinal cord, lungs and liver at different dose levels. For example, the risk of symptomatic pneumonitis in the lungs is estimated at 5% if the mean lung dose is 7Gy, but rises to 40% if the mean dose is 27Gy. The table aims to guide safe dose constraints in radiation therapy planning by organ to minimize complications.

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    This document summarizes dose and volume parameters associated with radiation-induced toxicity for various organs. It provides the estimated rate of adverse effects like necrosis, neuropathy or dysfunction for organs like brain, spinal cord, lungs and liver at different dose levels. For example, the risk of symptomatic pneumonitis in the lungs is estimated at 5% if the mean lung dose is 7Gy, but rises to 40% if the mean dose is 27Gy. The table aims to guide safe dose constraints in radiation therapy planning by organ to minimize complications.

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    © All Rights Reserved
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    1K views4 pages

    Quante C

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    Anonymous faRVVGN
    This document summarizes dose and volume parameters associated with radiation-induced toxicity for various organs. It provides the estimated rate of adverse effects like necrosis, neuropathy or dysfunction for organs like brain, spinal cord, lungs and liver at different dose levels. For example, the risk of symptomatic pneumonitis in the lungs is estimated at 5% if the mean lung dose is 7Gy, but rises to 40% if the mean dose is 27Gy. The table aims to guide safe dose constraints in radiation therapy planning by organ to minimize complications.

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    of 4

    Table 1.

    QUANTEC Summary: Approximate Dose/Volume/Outcome Data for Several Organs Following Conventional Fractionation (Unless Otherwise Noted)*

    Organ
    Brain

    Brain stem

    Spinal cord

    Cochlea

    Parotid

    Irradiation type
    (partial organ unless
    otherwise stated)y

    Endpoint

    Dose (Gy), or
    dose/volume
    parametersy

    Rate (%)
    <3
    5
    10

    Notes on
    dose/volume parameters

    Whole organ
    Whole organ
    Whole organ

    3D-CRT
    3D-CRT
    3D-CRT

    Symptomatic necrosis
    Symptomatic necrosis
    Symptomatic necrosis

    Dmax <60
    Dmax = 72
    Dmax = 90

    Whole organ

    SRS (single fraction)

    Symptomatic necrosis

    V12 <510 cc

    Whole organ

    Whole organ

    Dmax <54

    <5

    Whole organ

    3D-CRT

    Permanent cranial
    neuropathy or necrosis
    Permanent cranial
    neuropathy or necrosis

    D110 cck #59

    <5

    Whole organ

    3D-CRT

    Permanent cranial
    neuropathy or necrosis

    Dmax <64

    <5

    Point dose <<1 cc

    Whole organ

    SRS (single fraction)

    Permanent cranial
    neuropathy or necrosis

    Dmax <12.5

    <5

    For patients with acoustic tumors

    Whole organ
    Whole organ
    Whole organ

    3D-CRT
    3D-CRT
    3D-CRT

    Optic neuropathy
    Optic neuropathy
    Optic neuropathy

    Dmax <55
    Dmax 5560
    Dmax >60

    <3
    37
    >7-20

    Whole organ

    SRS (single fraction)

    Optic neuropathy

    Dmax <12

    Partial organ
    Partial organ
    Partial organ

    3D-CRT
    3D-CRT
    3D-CRT

    Myelopathy
    Myelopathy
    Myelopathy

    Dmax = 50
    Dmax = 60
    Dmax = 69

    0.2
    6
    50

    Partial organ
    Partial organ

    SRS (single fraction)


    SRS (hypofraction)

    Myelopathy
    Myelopathy

    Dmax = 13
    Dmax = 20

    1
    1

    Whole organ

    3D-CRT

    Sensory neural hearing loss

    Mean dose #45

    <30

    Mean dose to cochlear, hearing at 4


    kHz

    Whole organ

    SRS (single fraction)

    Sensory neural hearing loss

    Prescription dose #14

    <25

    Serviceable hearing

    Bilateral whole
    parotid glands

    3D-CRT

    Long term parotid salivary


    function reduced to <25% of
    pre-RT level

    Mean dose <25

    <20

    For combined parotid glands{

    Unilateral whole
    parotid gland

    3D-CRT

    Long term parotid salivary


    function reduced to <25% of
    pre-RT level

    Mean dose <20

    <20

    For single parotid gland.


    At least one parotid gland spared to
    <20 Gy{

    use <8

    <20

    Data at 72 and 90 Gy, extrapolated


    from BED models
    Rapid rise when V12 > 510 cc

    Given the small size, 3D CRT is often


    whole organzz

    <10
    Including full cord cross-section

    Partial cord cross-section irradiated


    3 fractions, partial cord cross-section
    irradiated

    Use of NTCP models in the clinic d L. B. MARKS et al.

    Optic
    nerve / chiasm

    Volume
    segmented

    (Continued )
    S15

    Organ

    Volume
    segmented

    Irradiation type
    (partial organ unless
    otherwise stated)y

    Endpoint

    Dose (Gy), or
    dose/volume
    parametersy

    Rate (%)

    Notes on
    dose/volume parameters

    Long term parotid salivary


    function reduced to <25% of
    pre-RT level

    Mean dose <39

    <50

    For combined parotid glands (per


    Fig. 3 in paper) {

    Pharynx

    Pharyngeal
    constrictors

    Whole organ

    Symptomatic dysphagia and


    aspiration

    Mean dose <50

    <20

    Based on Section B4 in paper

    Larynx

    Whole organ

    3D-CRT

    Vocal dysfunction

    Dmax <66

    <20

    With chemotherapy, based on single


    study (see Section A4.2 in paper)

    Whole organ

    3D-CRT

    Aspiration

    Mean dose <50

    <30

    With chemotherapy, based on single


    study (see Fig. 1 in paper)

    Whole organ

    3D-CRT

    Edema

    Mean dose <44

    <20

    Whole organ

    3D-CRT

    Edema

    V50 <27%

    <20

    Without chemotherapy, based


    on single study in patients without
    larynx cancer**

    Whole organ

    3D-CRT

    Symptomatic pneumonitis

    V20 # 30%

    <20

    For combined lung. Gradual dose


    response

    Whole organ
    Whole organ
    Whole organ
    Whole organ
    Whole organ

    3D-CRT
    3D-CRT
    3D-CRT
    3D-CRT
    3D-CRT

    Symptomatic pneumonitis
    Symptomatic pneumonitis
    Symptomatic pneumonitis
    Symptomatic pneumonitis
    Symptomatic pneumonitis

    Mean dose = 7
    Mean dose = 13
    Mean dose = 20
    Mean dose = 24
    Mean dose = 27

    5
    10
    20
    30
    40

    Excludes purposeful whole lung


    irradiation

    Whole organ

    3D-CRT

    Grade $3 acute esophagitis

    Mean dose <34

    520

    Based on RTOG and several studies

    Whole organ

    3D-CRT

    Grade $2 acute esophagitis

    V35 <50%

    <30

    Whole organ
    Whole organ

    3D-CRT
    3D-CRT

    Grade $2 acute esophagitis


    Grade $2 acute esophagitis

    V50 <40%
    V70 <20%

    <30
    <30

    A variety of alternate threshold doses


    have been implicated.
    Appears to be a dose/volume response

    Pericardium
    Pericardium

    3D-CRT
    3D-CRT

    Pericarditis
    Pericarditis

    Mean dose <26


    V30 <46%

    <15
    <15

    Whole organ

    3D-CRT

    Long-term cardiac mortality

    V25 <10%

    Esophagus

    Heart

    <1

    Based on single study


    Overly safe risk estimate based on
    model predictions
    (Continued )

    Volume 76, Number 3, Supplement, 2010

    3D-CRT

    I. J. Radiation Oncology d Biology d Physics

    Bilateral whole
    parotid glands

    Lung

    S16

    Table 1. QUANTEC Summary: Approximate Dose/Volume/Outcome Data for Several Organs Following Conventional Fractionation (Unless Otherwise Noted)* (Continued )

    Table 1. QUANTEC Summary: Approximate Dose/Volume/Outcome Data for Several Organs Following Conventional Fractionation (Unless Otherwise Noted)* (Continued )

    Organ

    Volume
    segmented

    Irradiation type
    (partial organ unless
    otherwise stated)y

    Endpoint

    Dose (Gy), or
    dose/volume
    parametersy

    Rate (%)

    Notes on
    dose/volume parameters

    Whole liver GTV

    3D-CRT or
    Whole organ

    Classic RILDyy

    Mean dose <30-32

    Whole liver GTV

    3D-CRT

    Classic RILD

    Mean dose <42

    <50

    Whole liver GTV

    3D-CRT or
    Whole organ

    Classic RILD

    Mean dose <28

    <5

    Whole liver GTV

    3D-CRT

    Classic RILD

    Mean dose <36

    <50

    Whole liver GTV

    SBRT (hypofraction)

    Classic RILD

    Whole liver GTV

    SBRT (hypofraction)

    Classic RILD

    Mean dose <13


    <18
    Mean dose <15
    <20

    <5
    <5
    <5
    <5

    3 fractions, for primary liver cancer


    6 fractions, for primary liver cancer
    3 fractions, for liver metastases
    6 fractions, for liver metastases

    >700 cc of normal liver

    SBRT (hypofraction)

    Classic RILD

    <5

    Critical volume based, in 35


    fractions

    Bilateral whole kidneyz

    Clinically relevant renal


    dysfunction
    Clinically relevant renal
    dysfunction

    Mean dose <1518

    Bilateral whole kidneyz

    Bilateral whole organ


    or 3D-CRT
    Bilateral whole organ

    Bilateral whole kidneyz

    3D-CRT

    Clinically relevant renal


    dysfuntction

    V12 <55%
    V20 <32%
    V23 <30%
    V28 <20%

    <5

    Stomach

    Whole organ

    Whole organ

    Ulceration

    D100k <45

    <7

    Small bowel

    Individual small bowel loops

    3D-CRT

    Grade $ 3 acute toxicityx

    V15 <120 cc

    <10

    Volume based on segmentation of


    the individual loops of bowel, not the
    entire potential peritoneal space

    Entire potential space within


    peritoneal cavity

    3D-CRT

    Grade $ 3 acute toxicityx

    V45 <195 cc

    <10

    Volume based on the entire potential


    space within the peritoneal cavity

    Liver

    Mean dose <28

    use <10

    Excluding patients with pre-existing


    liver disease or hepatocellular
    carcinoma, as tolerance doses
    are lower in these patients
    In patients with Child-Pugh A
    preexisting liver disease or
    hepatocellular carcinoma,
    excluding hepatitis B
    reactivation
    as an endpoint

    <5
    <50
    For combined kidney

    Use of NTCP models in the clinic d L. B. MARKS et al.

    Kidney

    Dmax <15

    <5

    (Continued )

    S17

    Organ
    Rectum

    Endpoint

    Dose (Gy), or
    dose/volume
    parametersy

    Grade $ 2 late rectal toxicity,


    Grade $ 3 late rectal toxicity
    Grade $ 2 late rectal toxicity,
    Grade $ 3 late rectal toxicity
    Grade $ 2 late rectal toxicity,
    Grade $ 3 late rectal toxicity
    Grade $ 2 late rectal toxicity,
    Grade $ 3 late rectal toxicity
    Grade $ 2 late rectal toxicity,
    Grade $ 3 late rectal toxicity

    V50 <50%

    3D-CRT

    Grade $ 3 late RTOG

    Dmax <65

    Whole organ

    3D-CRT

    Grade $3 late RTOG

    V65 #50 %
    V70 #35 %
    V75 #25 %
    V80 #15 %

    Whole organ

    3D-CRT

    Severe erectile dysfunction

    Whole organ
    Whole organ

    3D-CRT
    3D-CRT

    Severe erectile dysfunction


    Severe erectile dysfunction

    Mean dose to
    95% of gland <50
    D90k <50
    D60-70 <70

    Whole organ

    3D-CRT

    Whole organ

    3D-CRT

    Whole organ

    3D-CRT

    Whole organ

    3D-CRT

    Whole organ

    3D-CRT

    Whole organ

    V60 <35%
    V65 <25%
    V70 <20%
    V75 <15%

    Rate (%)
    <15
    <10
    <15
    <10
    <15
    <10
    <15
    <10
    <15
    <10
    <6

    Notes on
    dose/volume parameters
    Prostate cancer treatment

    Bladder cancer treatment.


    Variations in bladder size/shape/
    location during RT hamper ability to
    generate accurate data
    Prostate cancer treatment
    Based on current RTOG 0415
    recommendation

    <35
    <35
    <55

    Abbreviations: 3D-CRT = 3-dimensional conformal radiotherapy, SRS = stereotactic radiosurgery, BED = Biologically effective dose, SBRT = stereotactic body radiotherapy, RILD = radiation-induced liver disease, RTOG = Radiation Therapy Oncology Group.
    * All data are estimated from the literature summarized in the QUANTEC reviews unless otherwise noted. Clinically, these data should be applied with caution. Clinicians are strongly advised
    to use the individual QUANTEC articles to check the applicability of these limits to the clinical situation at hand. They largely do not reflect modern IMRT.
    y
    All at standard fractionation (i.e., 1.82.0 Gy per daily fraction) unless otherwise noted. Vx is the volume of the organ receiving $ x Gy. Dmax = Maximum radiation dose.
    z
    Non-TBI.
    x
    With combined chemotherapy.
    k
    Dx = minimum dose received by the hottest x% (or x ccs) of the organ.
    {
    Severe xerostomia is related to additional factors including the doses to the submandibular glands.
    ** Estimated by Dr. Eisbruch.
    yy
    Classic Radiation induced liver disease (RILD) involves anicteric hepatomegaly and ascites, typically occurring between 2 weeks and 3 months after therapy. Classic RILD also involves
    elevated alkaline phosphatase (more than twice the upper limit of normal or baseline value).
    zz
    For optic nerve, the cases of neuropathy in the 55 to 60 Gy range received z59 Gy (see optic nerve paper for details). Excludes patients with pituitary tumors where the tolerance may be
    reduced.

    Volume 76, Number 3, Supplement, 2010

    Penile bulb

    Irradiation type
    (partial organ unless
    otherwise stated)y

    I. J. Radiation Oncology d Biology d Physics

    Bladder

    Volume
    segmented

    S18

    Table 1. QUANTEC Summary: Approximate Dose/Volume/Outcome Data for Several Organs Following Conventional Fractionation (Unless Otherwise Noted)* (Continued )

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