Radiation Oncology/Toxicity/Hansen

Dose Tolerance Guidelines Adapted from Handbook of Evidence-Based Radiation Oncology (1st Edition) Organ Partial Organ Tolerance (1.8 - 2.0 Gy/fx) Brain Whole brain Partial brain Temporal lobe 50 Gy 60 Gy 70 Gy Brainstem Whole Point dose 54 Gy 60 Gy Spinal cord   45-50 Gy Optic chiasm   50-54 Gy Optic nerve   <54 Gy Retina   45 Gy Lens   10 Gy Inner Ear   30 Gy Sensorineural 45-50 Gy Cochlea   50 Gy Epilation   25 Gy Lacrimal gland   30 Gy (transient) 60 Gy (permanent) Parotid gland V24 Mean Contralateral <50% <26 Gy <20 Gy TMJ   <70 Gy Mandible Adult Peds 60-70 Gy 20-40 Gy Tracheostomy Elective Involved 50 Gy 60-66 Gy Thyroid Peds V20 26 Gy Brachial plexus   <60 Gy Esophagus 1/3 2/3 3/3 60 Gy 55-58 Gy 45-55 Gy Lung 2/3 volume V20 D70 Peds whole lung <1.5 yr Peds whole lung >1.5 yr Peds 2/3 <20 Gy 20-30% <20 Gy 9 Gy 12 Gy <15 Gy Heart D50 D50 D70 Peds whole <25-40 Gy <25 Gy 25-40 Gy <15 Gy Stomach Whole <45 Gy Liver D70 Whole liver 1/3 D36 Peds 1/2 <30 Gy <20 Gy 68.4 Gy in 38 fx <30% <19.8 Gy Kidney 2/3 volume Contralateral kidney Whole abdomen Contralateral Wilms Contralateral Neuroblastoma D80 <20 Gy <20 Gy <15 Gy each <14.4 Gy <12 Gy Small bowel Small volume Whole 50 Gy <40 Gy Ureter   <75 Gy Bladder Whole Whole 1/3 1/3 GYN HDR 50 Gy (5-10% late) 60 Gy (10-40% late) 60 Gy (5-10% late) 70 Gy (20% late) <70% Point A Urethra   60-70 Gy Rectum Whole GYN HDR 60 Gy <70% Point A Femoral head Adult Slipped epiphysis Avascular necrosis 42-50 Gy <25 Gy 30-40 Gy Testis Transient azoospermia Total azoospermia Sterilization 0.5 Gy 0.8-1 Gy 2-3 Gy Ovary Sterilization Ovarian failure 2-3 Gy 5-10 Gy Vagina Upper mucosa Mid mucosa Lower mucosa Fibrosis/stenosis 120 Gy 80-90 Gy 60-70 Gy >50-60 Gy Bone marrow Whole abdomen Ablation <30 Gy >40 Gy Bone Cortex 50 Gy Joint space Fibrotic constriction 40-45 Gy Extremity Circumferential 20-30 Gy