Radiation Oncology/Toxicity/Milano
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Dose Tolerance Guidelines
- Milano (2007), University of Rochester - PMID 17395043 — "Normal tissue tolerance dose metrics for radiation therapy of major organs." (Milano MT, Semin Radiat Oncol. 2007 Apr;17(2):131-40.)
- Review. Summary of dose guidelines, but with more emphasis on 3-dimensional dose distribution (i.e. DVH parameters) and partial irradiation than in previous publications (e.g. Emami)
| Organ | Dose tolerance | Endpoint RTOG/EORTC Late Radiation Morbidity Schema |
|---|---|---|
| Brainstem | V60 < 0.9 mL | <5% grade >= 1 toxicity |
| Spinal cord | Max < 50 Gy | <5% grade >= 3 toxicity |
| Cervical spinal cord | EUD < 52 Gy Max < 55 Gy |
<5% grade >= 3 toxicity |
| Parotid | Mean dose < 26 Gy | Late grade 2 xerostomia resulting from >75% functional loss |
| Lung | V13 < 40% V20 < 25-30% V30 < 10-15% MLD < 10-20 Gy |
Late grade 2 in <10-20% Late grade 3 in <5-10% |
| Heart | V33 < 60% V38 < 33% V42 < 20% |
5% excess cardiac mortality |
| Esophagus | V50 and S50 < 30% | 5% risk of late toxicity |
| Rectum | V70-80 <= 15 cc V70 <= 20-25% |
Late grade 2 in < 5-10% |
| Liver | 1/3: 40-80 Gy 2/3: 30-50 Gy 3/3: 25-35% |
Late grade 3-4 liver toxicity < 5% |
| Kidney | median dose < 17.5 Gy | anemia, azotemia, HTN, edema |