Radiation Oncology/Toxicity/RTOG

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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 60% 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 40% 70 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 50% 35 Gy   0529 Anus
Large Bowel 1.8 Gy 35% 40 Gy   0529 Anus
Large Bowel 1.8 Gy 5% 50 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
Longs, 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 V50 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 52.5 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 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 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.