Tissue Dose Tolerances

Emami Paper

presented a dose for different treatment sites at which 5% of patients would suffer a complication.

• did not consider concurrent chemo

• did no use rx or calcs with heterogeneity calcs

• mostly 3D

QUANTEC Constraint and Endpoint: Brain

1. Endpoint: Necrosis (death of tissue)

2. 3D-CRT: Dmax < 60 Gy (<3% complication rate)

3. SRS (Single Fraction): V12 (volume receiving 12 Gy) < 10 cc (<20% complication rate)

QUANTEC Constraint and Endpoint: Brainstem

1. Endpoint: Necrosis or neuropathy (damage to a nerve resulting in loss of associated function)

2. 3D-CRT: Dmax < 54 Gy (<5% complication rate)

3. SRS (Single Fraction): Dmax < 12.5 Gy (<5% complication rate)

QUANTEC Constraint and Endpoint: Optics/BrainChiasm

1. Endpoint: neuropathy (optic to be precise)

2. 3D-CRT: Dmax < 55 Gy (<3% complication rate)

3. SRS (Single Fraction): Dmax < 12 Gy (<10% complication rate)

QUANTEC Constraint and Endpoint: Spinal Cord

1. Endpoint: myelopathy (spinal cord dysfunction)

2. 3D-CRT: Dmax = 50 Gy (0.2% complication rate)

3. SRS (Single Fraction): 13 Gy (1% complication rate)

4. SRS (Hypofractionation): 20 Gy (1% complication rate)

QUANTEC Constraint and Endpoint: Chochlea

1. Endpoint: sensory hearing loss

2. 3D-CRT: Mean Dose < 45 Gy (<30% complication rate)

3. SRS (Single Fraction): prescription dose < 14 Gy (<25% complication rate)

QUANTEC Constraint and Endpoint: Parotids

1. Endpoint: loss of parotid salivary function

2. 3D-CRT: Mean Dose < 25 Gy (<20% complication rate)

QUANTEC Constraint and Endpoint: Lungs

1. Endpoint: pneumonitis

2. 3D-CRT:V20 < 30% (<20% complication rate)

QUANTEC Constraint and Endpoint: Esophagus

1. Endpoint: esophagitis

2. 3D-CRT: Mean Dose < 34 Gy (5-20% complication rate)

QUANTEC Constraint and Endpoint: Heart

1. Endpoint: pericarditis (inflammation of the pericardium)

2. 3D-CRT: V25 < 10% (<1% complication rate)

QUANTEC Constraint and Endpoint: Liver

1. Endpoint: Hepatitis and RILD (Radiation Induced Lung Disease - can involve pneumonitis and fibrosis.  Note: this is for the right lung for a whole liver GTV)

2. 3D-CRT: Mean Dose < 30 Gy (<5% complication rate)

3. SRS (Hypofractionation): Mean Dose < 13 Gy (<5% complication rate)

QUANTEC Constraint and Endpoint: Kidneys

1. Endpoint: renal dysfunction

2. 3D-CRT: V20 < 32% (<5% complication rate)

QUANTEC Constraint and Endpoint: Small Bowel

1. Endpoint: bowel toxicity diarrhea

2. 3D-CRT: V15 < 120 cc (<10% complication rate)

QUANTEC Constraint and Endpoint: rectum

1. Endpoint: rectal toxicity (fistulas)

2. 3D-CRT: V50 < 50% (<15% complication rate)

QUANTEC Constraint and Endpoint: bladder

1. Endpoint: toxicity (loss of urinary control)

2. 3D-CRT: V65 < 50%

QUANTEC Constraint and Endpoint: penile bulb

1. Endpoint: erectile dysfunction

2. 3D-CRT: V50 < 90% (<35% complication rate)