Radiation Oncology/Toxicity/QUANTEC

Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) 2010 Red Journal Issue or ScienceDirect 2010 PMID 20171502 -- "Use of normal tissue complication probability models in the clinic." (Marks LB, Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S10-9.) Conventional fractionated 3D-CRT Critical Structure Volume Dose/Volume Max Dose Toxicity Rate Toxicity Endpoint Brain     <60 Gy <3% Symptomatic necrosis Brain     72 Gy 5% Symptomatic necrosis Brain     90 Gy 10% Symptomatic necrosis Brain stem     <54 Gy <5% Neuropathy or necrosis Brain stem D1-10 cc <= 59 Gy   <5% Neuropathy or necrosis Brain stem     <64 Gy <5% Neuropathy or necrosis Optic nerve/chiasm     <55 Gy <3% Optic neuropathy Optic nerve/chiasm     55-60 Gy 3-7% Optic neuropathy Optic nerve/chiasm     >60 Gy >7-20% Optic neuropathy Spinal cord     50 Gy 0.2% Myelopathy Spinal cord     60 Gy 6% Myelopathy Spinal cord     69 Gy 50% Myelopathy Cochlea Mean <=45 Gy   <30% Sensory-neural hearing loss Parotid, bilateral Mean <=25 Gy   <20% Long-term salivary function <25% Parotid, bilateral Mean <=39 Gy   <50% Long-term salivary function <25% Parotid, unilateral Mean <=20 Gy   <20% Long-term salivary function <25% Pharyngeal constrictors Mean <=50 Gy   <20% Symptomatic dysphagia and aspiration Larynx     <66 Gy <20% Vocal dysfunction Larynx Mean <50 Gy   <30% Aspiration Larynx Mean <44 Gy   <20% Edema Larynx V50 <27%   <20% Edema Lung V20 <=30%   <20% Symptomatic pneumonitis Lung Mean 7 Gy   5% Symptomatic pneumonitis Lung Mean 13 Gy   10% Symptomatic pneumonitis Lung Mean 20 Gy   20% Symptomatic pneumonitis Lung Mean 24 Gy   30% Symptomatic pneumonitis Lung Mean 27 Gy   40% Symptomatic pneumonitis Esophagus Mean <34 Gy   5-20% Grade 3+ esophagitis Esophagus V35 <50%   <30% Grade 2+ esophagitis Esophagus V50 <40%   <30% Grade 2+ esophagitis Esophagus V70 <20%   <30% Grade 2+ esophagitis Heart (Pericardium) Mean <26 Gy   <15% Pericarditis Heart (Pericardium) V30 <46%   <15% Pericarditis Heart V25 <10%   <1% Long term cardiac mortality Liver Mean <30-32 Gy   <5% RILD (in normal liver function) Liver Mean <42 Gy   <50% RILD (in normal liver function) Liver Mean <28 Gy   <5% RILD (in Child-Pugh A or HCC) Liver Mean <36 Gy   <50% RILD (in Child-Pugh A or HCC) Kidney, bilateral Mean <15-18 Gy   <5% Clinical dysfunction Kidney, bilateral Mean <28 Gy   <50% Clinical dysfunction Kidney, bilateral V12 <55%   <5% Clinical dysfunction Kidney, bilateral V20 <32%   <5% Clinical dysfunction Kidney, bilateral V23 <30%   <5% Clinical dysfunction Kidney, bilateral V28 <20%   <5% Clinical dysfunction Stomach D100 <45 Gy   <7% Ulceration Small bowel (individual loops) V15 <120 cc   <10% Grade 3+ toxicity Small bowel (peritoneal cavity) V45 <195 cc   <10% Grade 3+ toxicity Rectum V50 <50%   <10% Grade 3+ toxicity Rectum V60 <35%   <10% Grade 3+ toxicity Rectum V65 <25%   <10% Grade 3+ toxicity Rectum V70 <20%   <10% Grade 3+ toxicity Rectum V75 <15%   <10% Grade 3+ toxicity Bladder (bladder cancer)     <65 <6% Grade 3+ toxicity Bladder (prostate cancer) V65 <50%     Grade 3+ toxicity Bladder (prostate cancer) V70 <35%     Grade 3+ toxicity Bladder (prostate cancer) V75 <25%     Grade 3+ toxicity Bladder (prostate cancer) V80 <15%     Grade 3+ toxicity Penile bulb Mean dose to 95% gland <50 Gy   <35% Severe erectile dysfunction Penile bulb D90 <50 Gy   <35% Severe erectile dysfunction Penile bulb D60-70 <70 Gy   <55% Severe erectile dysfunction Note: The “pericardium volume” was defined as a “rind” within the previously contoured heart volumes. The manually contoured heart volumes served as the outer border, and the inner border was automatically contoured 1 cm within these same contours using the planning. The heart pericardium contours on successive axial CT slices were meshed into a 3D structure (PMID 9422572). Stereotactic Radiosurgery (single fraction) Critical Structure Volume Dose/Volume Max Dose Toxicity Rate Toxicity Endpoint Brain V12 <5-10 cc   <20% Symptomatic necrosis Brain stem (acoustic tumors)     <12.5 Gy <5% Neuropathy or necrosis Optic nerve/chiasm     <12 Gy <10% Optic neuropathy Spinal cord (single-fx)     13 Gy 1% Myelopathy Spinal cord (hypo-fx)     20 Gy 1% Myelopathy Cochlea Prescription dose <=14 Gy   <25% Sensory-neural hearing loss Liver/HCC (3 fractions) Mean <13 Gy   <5% RILD Liver/Mets (3 fractions) Mean <15 Gy   <5% RILD Liver (3 fractions) >700 cc <15 Gy   <5% RILD