Radiation Oncology/Toxicity/UK Consensus SRS&SBRT

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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 FRACTION THREE (3) FRACTIONS FIVE (5) FRACTIONS
Serial Tissue Constraint Optimal (Gy) Mandatory (Gy) Optimal (Gy) Mandatory (Gy) Optimal (Gy) Mandatory (Gy) End Point (≥ Grade 3)
Optic Pathway D0.1cc -- 8 -- 15 -- 22.5 Optic Neuritis
Cochlea Dmean 4 9 -- 17.1 -- 25 Hearing Loss
Brainstem (not medulla) D0.1cc 10 15 18 23.1 23 31 Cranial Neuropathy
Spinal Canal D0.1cc 10 14 18 21.9 23 30 Myelitis
Cauda Equina & Sacral Plexus D0.1cc

D5cc

--

--

16

14

--

--

24

22

--

--

32

30

Neuritis
Normal Brain (Brain-GTV) D10cc

D50%

12

5

--

--

--

--

--

--

--

--

--

--

Necrosis

Cognitive Decline

Lenses D0.1cc) 1.5 -- -- -- -- -- Cataracts
Orbit D0.1cc 8 -- -- -- -- -- Retinopathy


Body (Not Prostate)

THREE (3) FRACTIONS FIVE (5) FRACTIONS
Serial Tissue Constraint Optimal (Gy) Mandatory (Gy) Optimal (Gy) Mandatory (Gy) End Point (≥ Grade 3)
Brachial Plexus D0.5cc 24 26 27 29 Neuropathy
Heart / Pericardium D0.5cc 24 26 27 29 Pericarditis
Great Vessels D0.5cc -- 45 -- 53 Aneurysm
Trachea & Large Bronchi D0.5cc 30 32 32 35 Stenosis / Fistula
Chest Wall D0.5cc

D30cc

37

30

--

--

39

32

--

--

Pain / Fracture
Lungs - GTV V20Gy -- 10% -- 10% Pneumonitis
Esophagus D0.5cc -- 25.2 32 34 Stenosis / Fistula
Stomach D0.5cc

D5cc

D10cc

D50cc

--

--

--

--

22.2

--

16.5

--

33

25

--

12

--

--

--

--

Ulceration / Fistula
Duodenum D0.5cc

D1cc

D5cc

D9cc

D10cc

--

--

--

--

--

22.2

--

16.5

--

11.4

--

33

25

15

--

35

--

--

--

25

Ulceration
Small Bowel D0.5cc

D5cc

D10cc

--

--

--

25.2

17

--

30

25

--

35

--

25

Enteritis / Obstruction
Large Bowel D0.5cc -- 28.2 -- 32 Colitis / Fistula
Rectum D0.5cc -- 28.2 -- 32 Proctitis / Fistula
Common Bile Duct D0.5cc 50 -- 50 -- Stenosis
Liver - GTV V10Gy

Dmean

D50%

rV700cc

--

--

15

15

--

--

--

19.2

70%

13

--

--

--

--

15.2

--

RILD
Kidneys (Each & Total) Dmean -- -- 10 -- Renal Dysfunction
D200cc -- 16 -- --
Kidneys (Each & Total) Dmean

D200cc

--

--

--

16

--

--

--

--

Renal Dysfunction
Solitary Functional Kidney

or Dmean of One Kidney > 10Gy

V10Gy -- -- 10% 45% Renal Dysfunction
Penile Bulb (non-prostate target) D0.5cc

D3cc

--

--

42

21.9

--

--

50

30

Impotence
Bladder (non-prostate target) D0.5cc

D3cc

--

--

28.2

16.8

--

--

38

18.3

Cystitis / Fistula
Ureter Dmax (0.5 cc) 40 45
Skin D0.5cc

D10cc

33

30

--

--

39.5

36.5

--

--

Ulceration
Femoral Head (each, non-prostate target) D10cc 21.9 -- 30 -- Fracture


Prostate SBRT

FIVE (5) FRACTIONS
Serial Tissue Constraint Optimal (Gy) Mandatory (Gy)
Rectum D50%

D20%

D1cc

--

--

--

18.1

29

36

Bladder D40%

V37Gy

--

5 cc

36

10 cc

Prostatic Urethra D50% 42 --
Femoral Head D5% -- 14.5
Penile Bulb D50% -- 29.5
Bowel D5cc

D1cc

--

--

18.1

30