Table 1.
Departmental OAR tolerances used in the reirradiation workflow. All tolerance doses are defined in EQD2. Structures that end in + 1 mm require a planning risk volume of 1 mm to be added. ‘Open’ refers to an open-ended constraint, and ‘no constraint’ refers to OARs that have no defined constraints, both of which should be discussed on a case-by-case basis. Values are based on in-house expert consensus of which are currently under evaluation in a prospective cohort to determine the safety of these dose limits.
|
Structure |
Alpha/Beta |
Parameter |
Eq2Gy |
|
|---|---|---|---|---|
|
Total Dose [Gy] |
||||
| Objective | Variation | |||
| Thorax | ||||
| Lungs | 3 | Dmean [Gy] | ≤ 22.00 | ≤ 26.00 |
| Lungs | 3 | D1500cc | ≤ 22.00 | ≤ 26.00 |
| Lung | 3 | V20 [Gy] | ≤ 40 % | |
| Brachial Plexus | 3 | D 3.0 cc [Gy] | ≤ 75.00 | ≤ 90.00 |
| Brachial Plexus | 3 | D0.03 cc [Gy] | ≤ 90.00 | ≤ 110.00 |
| Bronchial Tree | 3 | D0.1 cc [Gy] | ≤ 120.00 | ≤ 140.00 |
| Bronchial Tree | 3 | D0.03 cc [Gy] | ≤ 130.00 | ≤ 150.00 |
| Bronchial Tree | 3 | D5cc [Gy] | ≤ 90.00 | ≤ 95.00 |
| Thoracic Wall | 3 | D30cc [Gy] | ≤ 80.00 | ≤ 100.00 |
| Thoracic Wall | 3 | D5cc [Gy] | ≤ 120.00 | ≤ 140.00 |
| Esophagus | 3 | D0.03 cc [Gy] | ≤ 100.00 | ≤ 120.00 |
| Esophagus | 3 | D0.1 cc [Gy] | ≤ 90.00 | ≤ 110.00 |
| Esophagus | 3 | D1.00 cc [Gy] | ≤ 80.00 | ≤ 90.00 |
| Esophagus | 3 | D5.00 cc [Gy] | ≤ 70.00 | ≤ 90.00 |
| Heart | 3 | D15cc [Gy] | ≤ 60.00 | ≤ 80.00 |
| Heart | 3 | D0.1 cc [Gy] | ≤ 85.00 | ≤ 130.00 |
| Spinal Canal | 2 | D0.1 cc [Gy] | ||
| Great Vessels | 3 | D0.03 cc [Gy] | ≤ 120.00 | open |
| Abdomen | ||||
| Kidney | 3 | D200cc [Gy] | ≤ 15.00 | ≤ 20.00 |
| Kidney | 3 | D75% | ≤ 12.00 | ≤ 15.00 |
| Stomach | 3 | D0.1 cc [Gy] | ≤ 60.00 | ≤ 80.00 |
| Stomach | 3 | D1cc [Gy] | ≤ 54.00 | ≤ 70.00 |
| Duodenum | 3 | D0.1 cc [Gy] | ≤ 60.00 | ≤ 80.00 |
| Duodenum | 3 | D1cc [Gy] | ≤ 54.00 | ≤ 70.00 |
| Bowel | 3 | D0.1 cc [Gy] | ≤ 60.00 | ≤ 80.00 |
| Bowel | 3 | D0.5 cc [Gy] | ≤ 54.00 | ≤ 70.00 |
| Liver-GTV | 3 | D700cc [Gy] | ≤ 18.00 | ≤ 25.00 |
| Liver-GTV | 3 | Dmean [Gy] | ≤ 25.00 | ≤ 30.00 |
| Spinal Nerve | 2 | D0.1 cc [Gy] | ≤ 70.00 | ≤ 90.00 |
| Cauda Equina | 3 | D0.1 cc [Gy] | ≤ 67.00 | ≤ 85.00 |
| Sacral Plexus | 2 | D0.1 cc [Gy] | ≤ 67.00 | ≤ 85.00 |
| Pelvis | ||||
| Bladder | 3 | D0.5 cc [Gy] | ≤ 105.00 | ≤ 120.00 |
| Bladder | 3 | D2cc [Gy] | ≤ 95.00 | ≤ 105.00 |
| Rectum | 3 | D0.5 cc [Gy] | ≤ 105.00 | ≤ 110.00 |
| Rectum | 3 | D2cc [Gy] | ≤ 95.00 | ≤ 105.00 |
| Spinal Nerve | 2 | D0.03 cc [Gy] | ≤ 90.00 | ≤ 110.00 |
| Spinal Nerve | 2 | D1cc [Gy] | ≤ 75.00 | ≤ 90.00 |
| Ureter | 3 | no constraint | ||
| Urethra | 3 | no constraint | ||
| Femoral Head | 3 | no constraint | ||
| Penile Bulb | 3 | no constraint | ||
| Head and Neck | ||||
| Brainstem | 2 | D0.1 cc [Gy] | ≤ 68.00 | ≤ 80.00 |
| Chiasm | 2 | D0.03 cc [Gy] | ≤ 68.00 | ≤ 80.00 |
| Cochlea ipsilateral | 3 | Dmean [Gy] | ≤ 45.00 | ≤ 60.00 |
| Cochlea contralateral | 3 | Dmean [Gy] | ≤ 45.00 | ≤ 60.00 |
| Optic Nerve | 2 | D0.03 cc [Gy] | ≤ 68.00 | ≤ 80.00 |
| Trachea | 3 | D0.03 cc [Gy] | ≤ 120.00 | ≤ 140.00 |
| Trachea | 3 | D0.1 cc [Gy] | ≤ 110.00 | ≤ 120.00 |
| Brain | 3 | D0.1 cc [Gy] | ≤ 110.00 | ≤ 120.00 |
| Carotid Artery + 1 mm | 3 | D0.03 cc [Gy] | ≤ 100.00 | ≤ 135.00 |
| Mandible | 3 | Dmean [Gy] | ≤ 40.00 | ≤ 60.00 |
| Mandible | 3 | D0.1 cc [Gy] | ≤ 70.00 | ≤ 130.00 |
| Brain | ||||
| Brainstem | 2 | D0.1 cc [Gy] | ≤ 80.00 | ≤ 100.00 |
| Chiasm | 2 | D0.03 cc [Gy] | ≤ 68.00 | ≤ 80.00 |
| Optic Nerve | 2 | D0.03 cc [Gy] | ≤ 68.00 | ≤ 80.00 |
| Retina | 3 | D0.03 cc [Gy] | ≤ 70.00 | ≤ 80.00 |
| Lens | 3 | no constraint | ||
| Brain − GTV | 3 | D0.1 cc [Gy] | ≤ 100.00 | ≤ 120.00 |