Radiation Oncology/Toxicity/RTOG

RTOG Radiation Dose Constraints RTOG Radiation Dose Constraints RTOG Home Page 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.