Radiation Oncology/Toxicity/RTOG

Front Page: Radiation Oncology | RTOG Trials | Randomized Trials

RTOG Radiation Dose Constraints

Front Page: Radiation Oncology | RTOG Trials | Randomized Trials

RTOG Radiation Dose Constraints

Critical Structure	Dose/fx	Volume	Dose	Max Dose	Protocol	Treated organ
Anus	2 Gy	50%	30 Gy		0630	Sarcoma
Bladder	1.8 Gy	60%	50 Gy		0621	Prostate
Bladder*	1.8 Gy	70%	40 Gy		0534	Postop prostate
Bladder	1.8 Gy	55%	50 Gy		PMID 18947938	RTOG Prostate Group Consensus 2009
Bladder	1.8 Gy	50%	35 Gy		0529	Anus
Bladder	1.8 Gy	50%	65 Gy		0415	Prostate
Bladder	1.8 Gy	40%	40 Gy		0822	Rectum
Bladder*	1.8 Gy	50%	65 Gy		0534	Postop prostate
Bladder	1.8 Gy	40%	66.6 Gy		0621	Prostate
Bladder	1.8 Gy	35%	40 Gy		0529	Anus
Bladder	1.8 Gy	35%	45 Gy		0418	Endometrial
Bladder	1.8 Gy	35%	70 Gy		0415	Prostate
Bladder	1.8 Gy	30%	70 Gy		PMID 18947938	RTOG Prostate Group Consensus 2009
Bladder	1.8 Gy	25%	75 Gy		0415	Prostate
Bladder	1.8 Gy	15%	45 Gy		0822	Rectum
Bladder	1.8 Gy	15%	80 Gy		0415	Prostate
Bladder	1.8 Gy	5%	50 Gy		0529	Anus
Bladder	1.8 Gy			50 Gy	0822	Rectum
Bone, weightbearing	2 Gy	50%	50 Gy		0630	Sarcoma
Brachial Plexus	2 Gy	5%	60 Gy		0619	Postop H&N
Brachial Plexus	2 Gy			60 Gy	0522	Definitive H&N
Brachial Plexus	2 Gy			66 Gy	0619, 0617, 0615	Postop H&N, lung, nasopharynx
Brachial Plexus	3 Gy			36 Gy	0937	Lung
Brachial Plexus	4 Gy			30 Gy	0937	Lung
Brachial Plexus	10-12 Gy x5	3 cc	6 Gy/fx		0813	Lung SBRT
Brachial Plexus	10-12 Gy x5			6.4 Gy/fx	0813	Lung SBRT
Brachial Plexus	20 Gy x3			8 Gy/fx	0618	Lung SBRT
Brachial Plexus	16 Gy x1	3cc	14 Gy		0631	Spine SBRT
Brachial Plexus	16 Gy x1			17.5 Gy	0631	Spine SBRT
Brainstem	1.8-2 Gy	0.03 cc		55 Gy (0.03 cc)	0539	Intermediate risk meningioma
Brainstem	33 fxs			54 Gy	0615	Nasopharynx
Brainstem	1.8-2 Gy			60 Gy (0.03 cc)	0539, 0825	High risk meningioma, Glioblastoma
Brainstem PRV	2 Gy			52 Gy (0.03 cc	1016	Oropharynx
Bronchus/Trachea	10-12 Gy x5	4cc	3.6 Gy/fx	105% PTV	0813	Lung SBRT
Bronchus/Trachea	10-12 Gy x5			105% PTV	0813	Lung SBRT
Bronchus/Trachea	20 Gy x3			8 Gy/fx	0618	Lung SBRT
Cauda Equina	16 Gy x1	5cc	14 Gy		0631	Spine SBRT
Cauda Equina	16 Gy x1			16 Gy	0631	Spine SBRT
Cochlea	33 fxs	5%	55 Gy		0615	Nasopharynx
Colon	16 Gy x1	20 cc	14.3 Gy		0631	Spine SBRT
Colon	16 Gy x1			18.4 Gy	0631	Spine SBRT
Duodenum	16 Gy x1	10 cc	11.2 Gy		0631	Spine SBRT
Duodenum	16 Gy x1			16 Gy	0631	Spine SBRT
External genitalia	1.8 Gy	50%	20 Gy		0529	Anus
External genitalia	1.8 Gy	35%	30 Gy		0529	Anus
External genitalia	1.8 Gy	5%	40 Gy		0529	Anus
Esophagus	1.8 Gy	Mean	34 Gy		0623, 0617	Lung
Esophagus	1.8 Gy	10 cm	60 Gy		0623	Lung
Esophagus, cervical	2 Gy	Mean	30 Gy		1016	Oropharynx
Esophagus	3 Gy			47 Gy	0937	Lung
Esophagus, nonadjacent wall	10-12 Gy x5	5 cc	5.5 Gy/fx		0813	Lung SBRT
Esophagus, nonadjacent wall	10-12 Gy x5			105% PTV	0813	Lung SBRT
Esophagus	20 Gy x3			9 Gy/fx	0618	Lung SBRT
Esophagus	16 Gy x1	5cc	11.9 Gy		0631	Spine SBRT
Esophagus	16 Gy x1			16 Gy	0631	Spine SBRT
Femoral Head	1.8 Gy	50%	30 Gy		0529	Anus
Femoral Head	1.8 Gy	15%	30 Gy		0418	Endometrial
Femoral Head	1.8 Gy	40%	40 Gy		0822	Rectum
Femoral Head	1.8 Gy	35%	40 Gy		0529	Anus
Femoral Head	1.8 Gy	25%	45 Gy		0822	Rectum
Femoral Head*	1.8 Gy	10%	50 Gy		0534	Postop prostate
Femoral Head	1.8 Gy	5%	44 Gy		0529	Anus
Femoral Head	1.8 Gy	5%	50 Gy		PMID 18947938	RTOG Prostate Group Consensus 2009
Femoral Head	2 Gy	5%	60 Gy		0630	Sarcoma
Femoral Head	1.8 Gy			50 Gy	0822	Rectum
Femoral Head	1.8 Gy			45 Gy	0712	Bladder
Great Vessels	10-12 Gy x5	10 cc	9.4 Gy/fx		0813	Lung SBRT
Great Vessels	10-12 Gy x5			105% PTV	0813	Lung SBRT
Great Vessels	16 Gy x1	10 cc	31 Gy		0631	Spine SBRT
Great Vessels	16 Gy x1			37 Gy	0631	Spine SBRT
Heart	10-12 Gy x5	15 cc	5.5 Gy/fx		0813	Lung SBRT
Heart	10-12 Gy x5			105% PTV	0813	Lung SBRT
Heart	1.8 Gy	33%	60 Gy		0623, 0617	Lung
Heart	1.8 Gy	33%	50 Gy		0436	Esophagus
Heart	1.8 Gy	67%	45 Gy		0623, 0617, 0436	Lung, esophagus
Heart	1.8 Gy	100%	40 Gy		0623, 0617, 0436	Lung, esophagus
Heart	3 Gy			47 Gy	0937	Lung
Heart	3 Gy	V45	<30%		0937	Lung
Heart	20 Gy x3			8 Gy/fx	0618	Lung SBRT
Heart	16 Gy x1	15 cc	16 Gy		0631	Spine SBRT
Heart	16 Gy x1			22 Gy	0631	Spine SBRT
Iliac crests	1.8 Gy	50%	30 Gy		0529	Anus
Iliac crests	1.8 Gy	35%	40 Gy		0529	Anus
Iliac crests	1.8 Gy	5%	50 Gy		0529	Anus
Jejunum/Ileum	16 Gy x1	5cc	11.9 Gy		0631	Spine SBRT
Jejunum/Ileum	16 Gy x1			15.4 Gy	0631	Spine SBRT
Joints	2 Gy	50%	50 Gy		0630	Sarcoma
Kidney	1.8 Gy	100%	23 Gy		0436	Esophagus
Kidney	1.8 Gy	67%	30 Gy		0436	Esophagus
Kidney	1.8 Gy	33%	50 Gy		0436	Esophagus
Kidney	2 Gy	50%	14 Gy		0630	Sarcoma
Kidney	3 Gy	V18	< 25%		0937	Lung
Kidney (cortex)	16 Gy x1	200 cc	8.4 Gy		0631	Spine SBRT
Kidney (hilum)	16 Gy x1	2/3 volume	10.6 Gy		0631	Spine SBRT
Large Bowel	1.8 Gy	200cc	30 Gy		0529	Anus
Large Bowel	1.8 Gy	150cc	35 Gy		0529	Anus
Large Bowel	1.8 Gy	20cc	45 Gy		0529	Anus
Larynx, glottic	mean	20 Gy			1016	Oropharynx
Larynx	2 Gy			45 Gy	0619, 0615, 0522	Postop H&N, definitive H&N, nasopharynx
Lens	1.8-2 Gy			5 Gy (0.03 cc)	0539	Intermediate risk meningioma
Lens	1.8-2 Gy			7 Gy (0.03 cc)	0539, 0825	High risk meningioma, Glioblastoma
Lens	33 fxs			25 Gy	0615	Nasopharynx
Lips	2 Gy	Mean	<20 Gy		1016	Oropharynx
Liver	1.8 Gy	50%	35 Gy		0436	Esophagus
Liver	3 Gy	>700 cc	<18 Gy		0937	Lung
Lung, single	2 Gy	3 cm CW to field			0413	Breast
Lungs, total	2 Gy	V20	20%		0630	Sarcoma
Lungs, total	2 Gy	V20	37%		0617, 0623	Lung
Lungs, total	2 Gy	Mean	20 Gy		0617	Lung
Lungs, total	3 Gy	Mean	20 Gy		0937	Lung
Lungs, total	3 Gy	V20	<= 30%		0937	Lung
Lungs, total	10-12 Gy x5	1500 cc	2.5 Gy/fx		0813	Lung SBRT
Lungs, total	10-12 Gy x5	1000 cc	2.7 Gy/fx		0813	Lung SBRT
Lungs, total	20 Gy x3	V20	10%	8 Gy/fx	0618	Lung SBRT
Lungs, total	16 Gy x1	1000 cc	7.4 Gy		0631	Spine SBRT
Mandible/TM joint	2 Gy			66 Gy	1016	Oropharynx
Mandible/TM joint	33 fxs	1 cc	75 Gy		0615	Nasopharynx
Mandible/TM joint	33 fxs			70 Gy	0615	Nasopharynx
Optic chiasm	33 fxs			50 Gy	0615	Nasopharynx
Optic chiasm	1.8-2 Gy			54 Gy (0.03 cc)	0539	Intermediate risk meningioma
Optic chiasm	1.8-2 Gy			56 Gy (0.03 cc)	0539, 0825	High risk meningioma, Glioblastoma
Optic nerve	1.8-2 Gy			50 Gy (0.03 cc)	0539, 0615	Intermediate risk meningioma, nasopharynx
Optic nerve	1.8-2 Gy			55 Gy (0.03 cc)	0539, 0825	High risk meningioma, Glioblastoma
Oral cavity	33 fxs	Mean	<40 Gy		0615	Nasopharynx
Oral cavity (non-involved)	2 Gy	Mean	<30 Gy	60 Gy	1016	Oropharynx
Parotid Glands	2 Gy	Mean one gland	<26 Gy		0619, 0522, 1016	Postop H&N, Definitive H&N, Oropharynx
Parotid Glands	2 Gy	D50 one gland	<30 Gy		0619, 0522	Postop H&N, definitive H&N
Parotid Glands	2 Gy	Combined 20 cc	<20 Gy		0619, 0522	Postop H&N, definitive H&N
Pharynx, postcricoid	33 fxs			45 Gy	0615	Nasopharynx
Pharynx, posterior wall	2 Gy	33%	50Gy		1016	Oropharynx
Pharynx, posterior wall	2 Gy	15%	60Gy		1016	Oropharynx
Pharynx, posterior wall	2 Gy	Mean	45Gy		1016	Oropharynx
Penile Bulb	1.8 Gy	Mean	51 Gy		0415	Prostate
Rectum	1.8 Gy	60%	30 Gy		0418	Endometrial
Rectum	1.8-2 Gy	50%	55 Gy		0712	Bladder
Rectum	1.8 Gy	50%	50 Gy		0621, PMID 18947938	Prostate
Rectum	1.8 Gy	50%	60 Gy		0415	Prostate
Rectum	1.8 Gy	35%	65 Gy		0415	Prostate
Rectum	1.8 Gy	25%	66.6 Gy		0621	Prostate
Rectum	1.8 Gy	25%	70 Gy		0415	Prostate
Rectum	1.8 Gy	15%	75 Gy		0415	Prostate
Rectum*	1.8 Gy	55%	40 Gy		0534	Postop prostate
Rectum*	1.8 Gy	35%	65 Gy		0534	Postop prostate
Rectum	1.8 Gy	20%	70 Gy		PMID 18947938	RTOG Prostate Group Consensus 2009
Rectum	16 Gy x1	20 cc	14.3 Gy		0631	Spine SBRT
Rectum	16 Gy x1			18.4 Gy	0631	Spine SBRT
Retina	1.8-2 Gy			45 Gy (0.03 cc)	0539	Intermediate risk meningioma
Retina	1.8-2 Gy			50 Gy (0.03 cc)	0539, 0825, 0615	High risk meningioma, glioblastoma, nasopharynx
Sacral Plexus	16 Gy x1	5cc	14.4 Gy		0631	Spine SBRT
Sacral Plexus				18 Gy	0631	Spine SBRT
Small Bowel	1.8 Gy	200 cc	30 Gy		0529	Anus
Small Bowel	1.8 Gy	150 cc	35 Gy		0529	Anus
Small Bowel	1.8 Gy	180 cc	35 Gy		0822	Rectum
Small Bowel	1.8 Gy	100 cc	40 Gy		0822	Rectum
Small Bowel	1.8 Gy	20 cc	45 Gy		0529	Anus
Small Bowel	1.8 Gy	65 cc	45 Gy		0822	Rectum
Small Bowel	1.8 Gy			50 Gy	0822, 0529	Rectum, anus
Small Bowel	1.8 Gy			52 Gy	PMID 18947938	RTOG Prostate Group Consensus 2009
Small Bowel	1.8 Gy	30%	40 Gy		0418	Endometrial
Small Bowel	3 Gy	150 cc	30 Gy		0937	Lung
Small Bowel	3 Gy	100 cc	35 Gy		0937	Lung
Small Bowel	3 Gy	50 cc	40 Gy		0937	Lung
Small Bowel	3 Gy	1 cc	45 Gy		0937	Lung
Small Bowel	4 Gy	100 cc	30 Gy		0937	Lung
Small Bowel	4 Gy	50 cc	35 Gy		0937	Lung
Small Bowel	4 Gy	1 cc	40 Gy		0937	Lung
Skin	10-12 Gy x5	10 cc	6 Gy/fx		0813	Lung SBRT
Skin	10-12 Gy x5			6.4 Gy/fx	0813	Lung SBRT
Skin	20 Gy x3			8 Gy/fx	0618	Lung SBRT
Skin	16 Gy x1	10 cc	23 Gy		0631	Spine SBRT
Skin	16 Gy x1			26 Gy	0631	Spine SBRT
Skin, longitudinal	2 Gy	50%	20 Gy		0630	Sarcoma
Spinal Cord	1.8 Gy			45 Gy	0623, 0615	Lung, Nasopharynx
Spinal Cord	2 Gy			48 Gy (0.03 cc)	0619, 0522	Postop H&N, definitive H&N
Spinal Cord	2 Gy			50.5 Gy	0617	Lung
Spinal Cord	1.8 Gy	10 cm	50 Gy		0436	Esophagus
Spinal Cord	1.8 Gy	20 cm	47 Gy		0436	Esophagus
Spinal cord	3 Gy			36 Gy	0937	Lung
Spinal cord	4 Gy			30 Gy	0937	Lung
Spinal cord PRV	2 Gy	0.03	48 Gy		1016	Oropharynx
Spinal Cord	10-12 Gy x5	0.25 cc	4.5 Gy/fx		0813	Lung SBRT
Spinal Cord	10-12 Gy x5	0.5 cc	2.7 Gy/fx		0813	Lung SBRT
Spinal Cord	10-12 Gy x5			6 Gy/fx	0813	Lung SBRT
Spinal Cord	12 Gy x4	0.35 cc	5.2 Gy/fx		0915	Lung SBRT
Spinal Cord	12 Gy x4	1.2 cc	3.4 Gy/fx		0915	Lung SBRT
Spinal Cord	20 Gy x3			6 Gy/fx	0618	Lung SBRT
Spinal Cord*	16 Gy x1	1.2 cc	7 Gy		0631	Spine SBRT
Spinal Cord*	16 Gy x1	10%	10 Gy		0631	Spine SBRT
Spinal Cord	16 Gy x1	0.35 cc	10 Gy		0631	Spine SBRT
Stomach	16 Gy x1	10 cc	11.2 Gy		0631	Spine SBRT
Stomach	16 Gy x1			16 Gy	0631	Spine SBRT
Submandibular Gland	2 Gy	mean	<39 Gy		1016	Oropharynx
Testis	2 Gy	50%	3 Gy		0630	Sarcoma
Trachea/Larynx	16 Gy x1			20.2 Gy	0631	Spine SBRT
Trachea/Larynx	16 Gy x1	5cc	11.9 Gy		0631	Spine SBRT
Vulva	2 Gy	50%	30 Gy		0630	Sarcoma

Contouring

Dmax: 0.03 cc is approximately 3 mm x 3 mm x 3 mm cube
Bladder [0534]: should be contoured from its base to the dome, excluding the CTV1 (the CTV1 includes the bladder neck).
Femoral head [0534]: should be outlined down to the interface between the greater and lesser trochanters
Rectum [0534]: should be contoured from the anus (at the level of the ischial tuberosities) to the rectosigmoid flexure (this is roughly at about 10 cm) or for a maximum length of 15 cm if the sigmoid flexure if felt to be higher
Spinal cord [0631]: The spinal cord should be contoured starting from 5-6 mm above the superior extent of the target volume to 5-6 mm below the inferior extent of the target volume. The spinal cord should be drawn on every slice of simulation CT. The variation of 5-6 mm is due to the pre-determined slice thicknesses of 2.5-3 mm by different CT manufacturers.

This article is issued from Wikibooks. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.