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 |