Radiation Oncology/Toxicity/Milano

Dose Tolerance Guidelines Milano (2007), University of Rochester - PMID 17395043 — "Normal tissue tolerance dose metrics for radiation therapy of major organs." (Milano MT, Semin Radiat Oncol. 2007 Apr;17(2):131-40.) Review. Summary of dose guidelines, but with more emphasis on 3-dimensional dose distribution (i.e. DVH parameters) and partial irradiation than in previous publications (e.g. Emami) Organ Dose tolerance Endpoint RTOG/EORTC Late Radiation Morbidity Schema Brainstem V60 < 0.9 mL <5% grade >= 1 toxicity Spinal cord Max < 50 Gy <5% grade >= 3 toxicity Cervical spinal cord EUD < 52 Gy Max < 55 Gy <5% grade >= 3 toxicity Parotid Mean dose < 26 Gy Late grade 2 xerostomia resulting from >75% functional loss Lung V13 < 40% V20 < 25-30% V30 < 10-15% MLD < 10-20 Gy Late grade 2 in <10-20% Late grade 3 in <5-10% Heart V33 < 60% V38 < 33% V42 < 20% 5% excess cardiac mortality Esophagus V50 and S50 < 30% 5% risk of late toxicity Rectum V70-80 <= 15 cc V70 <= 20-25% Late grade 2 in < 5-10% Liver 1/3: 40-80 Gy 2/3: 30-50 Gy 3/3: 25-35% Late grade 3-4 liver toxicity < 5% Kidney median dose < 17.5 Gy anemia, azotemia, HTN, edema