Radiation Oncology/Toxicity/UK Consensus SRS&SBRT

UK Consensus on Normal Tissue Dose Constraints for Stereotactic Radiotherapy 2018 PMID 29033164-- "UK Consensus on Normal Tissue Dose Constraints for Stereotactic Radiotherapy" (Hanna GG, et al. Clinical Onology 2018 30:5-18.) Central Nervous System (CNS) SINGLE FRACTIONTHREE (3) FRACTIONSFIVE (5) FRACTIONSSerial TissueConstraintOptimal (Gy)Mandatory (Gy)Optimal (Gy)Mandatory (Gy)Optimal (Gy)Mandatory (Gy)End Point (≥ Grade 3)Optic PathwayD0.1cc --8 --15 --22.5Optic NeuritisCochleaDmean49 --17.1 --25Hearing LossBrainstem (not medulla)D0.1cc10151823.12331Cranial NeuropathySpinal CanalD0.1cc10141821.92330MyelitisCauda Equina & Sacral PlexusD0.1cc D5cc -- --16 14 -- --24 22 -- --32 30NeuritisNormal Brain (Brain-GTV)D10cc D50%12 5 -- -- -- -- -- -- -- -- -- --Necrosis Cognitive DeclineLensesD0.1cc)1.5 -- -- -- -- --CataractsOrbitD0.1cc8 -- -- -- -- --Retinopathy Body (Not Prostate) THREE (3) FRACTIONSFIVE (5) FRACTIONSSerial TissueConstraintOptimal (Gy)Mandatory (Gy)Optimal (Gy)Mandatory (Gy)End Point (≥ Grade 3)Brachial PlexusD0.5cc24262729NeuropathyHeart / PericardiumD0.5cc24262729PericarditisGreat VesselsD0.5cc --45--53AneurysmTrachea & Large BronchiD0.5cc30323235Stenosis / FistulaChest WallD0.5cc D30cc37 30 -- --39 32 -- --Pain / FractureLungs - GTVV20Gy --10% --10%PneumonitisEsophagusD0.5cc --25.23234Stenosis / FistulaStomachD0.5cc D5cc D10cc D50cc -- -- -- --22.2 -- 16.5 --33 25 -- 12 -- -- -- --Ulceration / FistulaDuodenumD0.5cc D1cc D5cc D9cc D10cc -- -- -- -- --22.2 -- 16.5 -- 11.4 -- 33 25 15 --35 -- -- -- 25UlcerationSmall BowelD0.5cc D5cc D10cc -- -- --25.2 17 --30 25 --35 -- 25Enteritis / ObstructionLarge BowelD0.5cc --28.2 --32Colitis / FistulaRectumD0.5cc --28.2 --32Proctitis / FistulaCommon Bile DuctD0.5cc50 --50 --StenosisLiver - GTVV10Gy Dmean D50% rV700cc -- -- 15 15 -- -- -- 19.270% 13 -- -- -- -- 15.2 --RILDKidneys (Each & Total)Dmean -- --10 --Renal DysfunctionD200cc --16 -- --Kidneys (Each & Total)Dmean D200cc -- -- -- 16 -- -- -- --Renal DysfunctionSolitary Functional Kidney or Dmean of One Kidney > 10Gy V10Gy -- --10%45%Renal DysfunctionPenile Bulb (non-prostate target)D0.5cc D3cc -- --42 21.9 -- --50 30ImpotenceBladder (non-prostate target)D0.5cc D3cc -- --28.2 16.8 -- --38 18.3Cystitis / FistulaUreterDmax (0.5 cc)4045SkinD0.5cc D10cc33 30 -- --39.5 36.5 -- --UlcerationFemoral Head (each, non-prostate target)D10cc21.9 --30 --Fracture Prostate SBRT FIVE (5) FRACTIONSSerial TissueConstraintOptimal (Gy)Mandatory (Gy)RectumD50% D20% D1cc -- -- --18.1 29 36BladderD40% V37Gy -- 5 cc36 10 ccProstatic UrethraD50%42 --Femoral HeadD5% --14.5Penile BulbD50% --29.5BowelD5cc D1cc -- --18.1 30