< Radiation Oncology < Toxicity
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Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC)
- 2010 Red Journal Issue or ScienceDirect
- 2010 PMID 20171502 -- "Use of normal tissue complication probability models in the clinic." (Marks LB, Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S10-9.)
Conventional fractionated 3D-CRT
| Critical Structure | Volume | Dose/Volume | Max Dose | Toxicity Rate | Toxicity Endpoint |
|---|---|---|---|---|---|
| Brain | <60 Gy | <3% | Symptomatic necrosis | ||
| Brain | 72 Gy | 5% | Symptomatic necrosis | ||
| Brain | 90 Gy | 10% | Symptomatic necrosis | ||
| Brain stem | <54 Gy | <5% | Neuropathy or necrosis | ||
| Brain stem | D1-10 cc | <= 59 Gy | <5% | Neuropathy or necrosis | |
| Brain stem | <64 Gy | <5% | Neuropathy or necrosis | ||
| Optic nerve/chiasm | <55 Gy | <3% | Optic neuropathy | ||
| Optic nerve/chiasm | 55-60 Gy | 3-7% | Optic neuropathy | ||
| Optic nerve/chiasm | >60 Gy | >7-20% | Optic neuropathy | ||
| Spinal cord | 50 Gy | 0.2% | Myelopathy | ||
| Spinal cord | 60 Gy | 6% | Myelopathy | ||
| Spinal cord | 69 Gy | 50% | Myelopathy | ||
| Cochlea | Mean | <=45 Gy | <30% | Sensory-neural hearing loss | |
| Parotid, bilateral | Mean | <=25 Gy | <20% | Long-term salivary function <25% | |
| Parotid, bilateral | Mean | <=39 Gy | <50% | Long-term salivary function <25% | |
| Parotid, unilateral | Mean | <=20 Gy | <20% | Long-term salivary function <25% | |
| Pharyngeal constrictors | Mean | <=50 Gy | <20% | Symptomatic dysphagia and aspiration | |
| Larynx | <66 Gy | <20% | Vocal dysfunction | ||
| Larynx | Mean | <50 Gy | <30% | Aspiration | |
| Larynx | Mean | <44 Gy | <20% | Edema | |
| Larynx | V50 | <27% | <20% | Edema | |
| Lung | V20 | <=30% | <20% | Symptomatic pneumonitis | |
| Lung | Mean | 7 Gy | 5% | Symptomatic pneumonitis | |
| Lung | Mean | 13 Gy | 10% | Symptomatic pneumonitis | |
| Lung | Mean | 20 Gy | 20% | Symptomatic pneumonitis | |
| Lung | Mean | 24 Gy | 30% | Symptomatic pneumonitis | |
| Lung | Mean | 27 Gy | 40% | Symptomatic pneumonitis | |
| Esophagus | Mean | <34 Gy | 5-20% | Grade 3+ esophagitis | |
| Esophagus | V35 | <50% | <30% | Grade 2+ esophagitis | |
| Esophagus | V50 | <40% | <30% | Grade 2+ esophagitis | |
| Esophagus | V70 | <20% | <30% | Grade 2+ esophagitis | |
| Heart (Pericardium) | Mean | <26 Gy | <15% | Pericarditis | |
| Heart (Pericardium) | V30 | <46% | <15% | Pericarditis | |
| Heart | V25 | <10% | <1% | Long term cardiac mortality | |
| Liver | Mean | <30-32 Gy | <5% | RILD (in normal liver function) | |
| Liver | Mean | <42 Gy | <50% | RILD (in normal liver function) | |
| Liver | Mean | <28 Gy | <5% | RILD (in Child-Pugh A or HCC) | |
| Liver | Mean | <36 Gy | <50% | RILD (in Child-Pugh A or HCC) | |
| Kidney, bilateral | Mean | <15-18 Gy | <5% | Clinical dysfunction | |
| Kidney, bilateral | Mean | <28 Gy | <50% | Clinical dysfunction | |
| Kidney, bilateral | V12 | <55% | <5% | Clinical dysfunction | |
| Kidney, bilateral | V20 | <32% | <5% | Clinical dysfunction | |
| Kidney, bilateral | V23 | <30% | <5% | Clinical dysfunction | |
| Kidney, bilateral | V28 | <20% | <5% | Clinical dysfunction | |
| Stomach | D100 | <45 Gy | <7% | Ulceration | |
| Small bowel (individual loops) | V15 | <120 cc | <10% | Grade 3+ toxicity | |
| Small bowel (peritoneal cavity) | V45 | <195 cc | <10% | Grade 3+ toxicity | |
| Rectum | V50 | <50% | <10% | Grade 3+ toxicity | |
| Rectum | V60 | <35% | <10% | Grade 3+ toxicity | |
| Rectum | V65 | <25% | <10% | Grade 3+ toxicity | |
| Rectum | V70 | <20% | <10% | Grade 3+ toxicity | |
| Rectum | V75 | <15% | <10% | Grade 3+ toxicity | |
| Bladder (bladder cancer) | <65 | <6% | Grade 3+ toxicity | ||
| Bladder (prostate cancer) | V65 | <50% | Grade 3+ toxicity | ||
| Bladder (prostate cancer) | V70 | <35% | Grade 3+ toxicity | ||
| Bladder (prostate cancer) | V75 | <25% | Grade 3+ toxicity | ||
| Bladder (prostate cancer) | V80 | <15% | Grade 3+ toxicity | ||
| Penile bulb | Mean dose to 95% gland | <50 Gy | <35% | Severe erectile dysfunction | |
| Penile bulb | D90 | <50 Gy | <35% | Severe erectile dysfunction | |
| Penile bulb | D60-70 | <70 Gy | <55% | Severe erectile dysfunction |
Note:
The “pericardium volume” was defined as a “rind” within the previously contoured heart volumes. The manually contoured heart volumes served as the outer border, and the inner border was automatically contoured 1 cm within these same contours using the planning. The heart pericardium contours on successive axial CT slices were meshed into a 3D structure (PMID 9422572).
Stereotactic Radiosurgery (single fraction)
| Critical Structure | Volume | Dose/Volume | Max Dose | Toxicity Rate | Toxicity Endpoint |
|---|---|---|---|---|---|
| Brain | V12 <5-10 cc | <20% | Symptomatic necrosis | ||
| Brain stem (acoustic tumors) | <12.5 Gy | <5% | Neuropathy or necrosis | ||
| Optic nerve/chiasm | <12 Gy | <10% | Optic neuropathy | ||
| Spinal cord (single-fx) | 13 Gy | 1% | Myelopathy | ||
| Spinal cord (hypo-fx) | 20 Gy | 1% | Myelopathy | ||
| Cochlea | Prescription dose | <=14 Gy | <25% | Sensory-neural hearing loss | |
| Liver/HCC (3 fractions) | Mean | <13 Gy | <5% | RILD | |
| Liver/Mets (3 fractions) | Mean | <15 Gy | <5% | RILD | |
| Liver (3 fractions) | >700 cc | <15 Gy | <5% | RILD |
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