Radiation Oncology/Toxicity/Milano

< Radiation Oncology‎ | Toxicity

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