Radiation Oncology/Toxicity/QUANTEC

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Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC)



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