TD5/5, Tissue Tolerances, Serial and Parallel Structures

ONCOL 309 - Clinical Oncology I. University of Alberta

Bladder TD5/5 Max dose and endpoint

65 Gy

• contracture/volume loss

Esophagus TD5/5 endpoint and max dose

55 Gy

• stricture

Femoral Heads TD5/5 max dose and endpoint

52 Gy

• necrosis

Heart TD5/5 max dose and endpoint (1/3)

60 Gy

• pericarditis

Large Bowel TD5/5 max dose and endpoint

45 Gy

• obstruction, ulcertaion, fistula, perforation

Liver TD5/5 max dose and endpoint

30 Gy

• liver failure

Lungs TD5/5 max dose and endpoint for 1/3

45 Gy

• pneumonitis

Lungs TD5/5 max dose and endpoint for 2/3

30 Gy

• pneumonitis

Lungs TD5/5 max dose and endpoint for 3/3

17 Gy

• pneumonitis

Kidney TD5/5 max dose and endpoint for 1/3

50 Gy

• nephritis

Kidney TD5/5 max dose and endpoint for 2/3

30 Gy

• nephritis

Kidney TD5/5 max dose and endpoint for 3/3

23 Gy

• nephritis

Rectum TD5/5 max dose and endpoint

60 Gy

• severe necrosis, stenosis, fistula

Colon TD5/5 max dose and endpoint

45 Gy

• obstruction / perforation

Skin TD 5/5 Max dose and endpoint

55 Gy in 100 cm2

• telangietasia

Spinal cord TD5/5 max dose and endpoint for 10 cm

10 cm = 50 Gy

• myelitis, necrosis

Spinal cord TD5/5 max dose and endpoint for 20 cm

20 cm = 47 Gy

• myelitis, necrosis

Small bowel (peritoneal cavity) TD5/5 max dose and endpoint

40 Gy

• obstruction, perforation

Stomach TD5/5 max dose and endpoint

50 Gy

• ulceration, perforation

Ovary TD5/5 max dose and endpoint for 1/3

6-12 Gy

• sterilization

Ovary TD5/5 max dose and endpoint for 3/3

2-3 Gy

• sterilization

Testis TD5/5 max dose and endpoint for 1/3

2 Gy

• sterilization

Testis TD5/5 max dose and endpoint for 3/3

1 Gy

• sterilization

Stomach acute dose-tissue response

10 Gy

N+V

Small bowel acute dose-tissue response

20 Gy

diarrhea

Esophagus acute dose-tissue response

20 Gy

esophagitis

skin acute dose-tissue response to 20 Gy

erythema

skin acute dose-tissue response to 30 Gy

dry desquamation

skin acute dose-tissue response to 40 Gy

moist desquamation

bladder acute dose-tissue response

30 Gy

cystitis

liver acute dose-tissue response

25 Gy

acute/chronic hepatitis

kidney acute dose-tissue response

15 Gy

nephrosclerosis

Brain TD5/5 max dose and endpoint

45 Gy

• necrosis

Brain stem TD5/5 maxdose and endpoint

50 Gy

• necrosis

Optic nerve TD5/5 max dose and endpoint

50 Gy

• blindness

Spinal cord TD5/5 max dose and endpoint for 20 cm

47 Gy

• myelitis necrosis

parotid TD5/5 max dose and endpoint

32 Gy

• xerostomia

Ear TD5/5 max dose and endpoint

55 Gy

• chronic serous otitis

Larynx TD5/5 max dose and endpoint

70 Gy

• necrosis

Retina TD5/5 max dose and endpoint

45 Gy

• blindness

Bone marrow TD5/5 max dose and endpoint for 1/3

25 Gy

• aplasia, pancytopenia

Bone marrow TD5/5 max dose and endpoint for 3/3

4.5 Gy

• aplasia, pancytopenia

TMJ Mandible TD5/5 max dose and endpoint

60 Gy

• decreased function

Lens TD5/5 max dose and endpoint

10 Gy

• cataracts

Taste buds acute dose-tissue response

10 Gy

taste changes

salivary glands acute dose-tissue response

10-20 Gy

xerostomia

cervical spinal cord acute dose-tissue response

20-30 Gy

Lhermitte’s sign

• numbness or tingling in limbs after neck flexion

oral mucosa acute dose-tissue response

20-30 Gy

mucositis

ear acute dose-tissue response

30 Gy

acute serous otitis

lacrimal gland acute dose-tissue response

40 Gy

dry eye

larynx acute dose-tissue response

45-50 Gy

edema / laryngitis

mandible acute dose-tissue response

60 Gy

trismus

pediatric bone acute dose-tissue response

10 Gy

growth arrest

pediatric lung acute dose-tissue response

15 Gy

pulmonary fibrosis

pediatric testis acute dose-tissue response

0.5-2 Gy

transient oligospermia

pediatric pituitary and hypothalamus acute dose-tissue response

20 Gy

hormone deficits

pediatric cochlea acute dose-tissue response

30 Gy

hearing impairment

serial or parallel: spinal cord

serial

serial or parallel: parotid gland

parallel

serial or parallel: inner/middle ear

parallel

serial or parallel: optic structures

serial

serial or parallel: temporal lobes

serial

serial or parallel: neck skin

parallel

serial or parallel: mandible and TMJ

serial