QUANTEC Summary:
Approximate Dose/Volume/Outcome Data for Several Organs Following Conventional Fractionation 3D-CRT
Organ
Endpoint
Brain
Symptomatic necrosis
Brain stem
Permanent cranial neuropathy or
necrosis
Dose (Gy), or
dose/volume parameters
Dmax <60
Dmax = 72
Dmax = 90
Dmax <54
D1–10 cc * ≤59
Dmax <64 <<1 cc (Point dose)
Dmax <55
Dmax 55–60
Dmax >60
Dmax = 50
Dmax = 60
Dmax = 69
<3
5
10
<5
<5
<5
<3
3–7
>7-20
0.2
6
50
<30
Optic nerve/
chiasm
Optic neuropathy
Spinal cord
Myelopathy
Cochlea
Sensory neural hearing loss
(hearing at 4 kHz)
Mean dose ≤45
Long term parotid salivary function
reduced to <25% of pre-RT level
Mean dose <25 (for combined
parotid glands)**
Mean dose <20 (for single parotid
gland)**
Mean dose <39 (for combined
parotid glands)**
Parotid
Pharynx
constrictors
Larynx
Lung
Symptomatic dysphagia and aspiration
Vocal dysfunction (with chemo, based
on single study)
Aspiration (with chemo, based on single
study)
Edema (without chemo, based on single
study in patients without larynx cancer)
Symptomatic pneumonitis
Rate
(%)
<20
<20
<50
Mean dose <50
<20
Dmax <66
<20
Mean dose <50
<30
Mean dose <44
V50 <27%
V20 ≤ 30% (for combined lung)
Mean dose = 7
Mean dose = 13
Mean dose = 20
Mean dose = 24
<20
<20
<20
5
10
20
30
Volume
segmented
Whole organ
Whole organ
Whole organ
Irradiation type
(partial organ
unless otherwise
stated)
3D-CRT
Whole organ
3D-CRT
3D-CRT
Given the small
size, 3D-CRT is
often whole organ
Partial organ
3D-CRT
Whole organ
Given the small
size, 3D-CRT is
often whole organ
Bilateral whole
parotid glands
Unilateral whole
parotid gland
Bilateral whole
parotid glands
3D-CRT
Pharyngeal
constrictors
Whole organ
Whole organ
3D-CRT
3D-CRT
Whole organ
3D-CRT (excludes
purposeful whole
lung irradiation)
Grade ≥3 acute esophagitis
Esophagus
Heart
Grade ≥2 acute esophagitis
Pericarditis (based on single study)
Long-term cardiac mortality
Liver
Classi
c RILD
***
Excluding patients with preexisting liver disease or HCC
In patients with Child-Pugh A
preexisting liver disease or
HCC, excluding hepatitis B
reactivation as an endpoint
Kidney
(Non-TBI)
Clinically relevant renal dysfunction
Stomach
Ulceration
Small bowel
Grade ≥ 3 acute toxicity (with combined
chemotherapy)
Mean dose = 27
Mean dose <34
V35 <50%
V50 <40%
V70 <20%
Mean dose <26
V30 <46%
V25 <10%
40
5–20
<30
<30
<30
<15
<15
<1
Mean dose <30-32
<5
Mean dose <42
<50
Mean dose <28
<5
Mean dose <36
<50
Mean dose <15–18
<5
Mean dose <28
<50
V12 <55% (for combined kidney)
V20 <32%
V23 <30%
V28 <20%
<5
D100* <45
<7
V15 <120 cc
<10
V45 <195 cc
Rectum
(Prostate cancer
treatment)
Grade ≥ 2 late toxicity
Grade ≥ 3 late toxicity
Grade ≥ 2 late toxicity
Grade ≥ 3 late toxicity
Grade ≥ 2 late toxicity
Grade ≥ 3 late toxicity
Grade ≥ 2 late toxicity
Grade ≥ 3 late toxicity
V50 <50%
V60 <35%
V65 <25%
V70 <20%
<10
<15
<10
<15
<10
<15
<10
<15
<10
Whole organ
Pericardium
3D-CRT
3D-CRT
Whole organ
Whole liver –
GTV
3D-CRT or whole
organ
3D-CRT
3D-CRT or whole
organ
3D-CRT
Bilateral whole
kidney
Bilateral whole
organ or 3D-CRT
Bilateral whole
organ
3D-CRT
Whole organ
Individual small
bowel loops (not
the entire
potential
peritoneal
space)
Entire potential
space within
peritoneal cavity
Whole organ
Whole organ
3D-CRT
3D-CRT
Grade ≥ 2 late toxicity
Grade ≥ 3 late toxicity
Bladder cancer treatment:
Bladder
Grade ≥ 3
late RTOG
Penile bulb
Severe erectile dysfunction
Prostate cancer treatment:
V75 <15%
Dmax <65
V65 ≤50 %
V70 ≤35 %
V75 ≤25 %
V80 ≤15 %
Mean dose to 95% of gland <50
D90*<50
D60-70 <70
<15
<10
<6
<35
<35
<55
Whole organ
3D-CRT
Whole organ
3D-CRT
Vx is the volume of the organ receiving ≥ x Gy.
*Dx = minimum dose received by the “hottest” x% (or x cc's) of the organ.
**Severe xerostomia is related to additional factors including the doses to the submandibular glands.
***Classic Radiation induced liver disease (RILD) involves anicteric hepatomegaly and ascites, typically occurring between 2 weeks and 3 months after
therapy. Classic RILD also involves elevated alkaline phosphatase (more than twice the upper limit of normal or baseline value).
HCC - hepatocellular carcinoma
Clinically, these data should be applied with caution. Clinicians are strongly advised to use the individual QUANTEC articles to check the
applicability of these limits to the clinical situation at hand. They largely do not reflect modern IMRT.
http://www.redjournal.org/issues?issue_key=S0360-3016%2810%29X0002-5