Radiation Oncology/Toxicity/RTOG
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RTOG Radiation Dose Constraints
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RTOG Radiation Dose Constraints
| 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 | 70% | 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 | 50% | 65 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 | 200cc | 30 Gy | 0529 | Anus | |
| Large Bowel | 1.8 Gy | 150cc | 35 Gy | 0529 | Anus | |
| Large Bowel | 1.8 Gy | 20cc | 45 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 |
| Lungs, 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 | D50 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 | 51 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 Gy | 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 | 12 Gy x4 | 0.35 cc | 5.2 Gy/fx | 0915 | Lung SBRT | |
| Spinal Cord | 12 Gy x4 | 1.2 cc | 3.4 Gy/fx | 0915 | 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.