Table 1.
Constraints for consideration when treating pelvic nodes
| 75.6–79.2 Gy in 42–44 fractions, treating nodes to 45–50.4 Gy with a sequential boost | |
| Rectum (24) | V (≥4500 cGy) ≤50% |
| V (≥7000 cGy) ≤15% | |
| V (>7200 cGy) <10 cm3 | |
| Bladder | V (≥4500 cGy) ≤50% |
| V (≥7000 cGy) ≤15% | |
| Femur_L | V (≥5000 cGy) ≤2% |
| Dmax ≤5250 cGy | |
| Femur_R | V (≥5000 cGy) ≤2% |
| Dmax ≤5250 cGy | |
| Colon | V (≥6000 cGy) ≤2% |
| Dmax ≤6250 cGy | |
| Small bowel (bowel loops) | V (≥5000 cGy) ≤10% |
| Dmax ≤5200 cGy | |
| Pubic bone | V (≥7000 cGy) ≤25% |
| Penile bulb (should not sacrifice PTV coverage) | V (≥5000 cGy) ≤50% |
| 70 Gy in 28 fractions, treating nodes to 45–50.4 Gy with a simultaneous integrated boost | |
| Rectum (24) | V (≥4500 cGy) ≤45% |
| V (≥5500 cGy) ≤25% | |
| V (≥ 6500 cGy) ≤15% | |
| V (>6500 cGy) <10 cm3 | |
| Bladder | V (≥4500 cGy) ≤45% |
| V (≥5500 cGy) ≤25% | |
| V (≥6500 cGy) ≤15% | |
| Femur_L | V (≥5000 cGy) ≤1% |
| Dmax ≤5250 cGy | |
| Femur_R | V (≥5000 cGy) ≤1% |
| Dmax ≤5250 cGy | |
| Colon | Dmax ≤5500 cGy |
| Small bowel (bowel loops) | V (≥4650 cGy) ≤2 cm3 |
| Dmax ≤5200 cGy | |
| Pubic bone | V (≥6000 cGy) ≤30% |
| Penile bulb (should not sacrifice PTV coverage) | Make dose as low as reasonably achievable |
| 60 Gy in 20 fractions (treating nodes to 44–47 Gy over 20 fractions*) (8) | |
| Rectum (22) | V (≥2000 cGy) ≥85% (no circumferential dose) |
| V (≥3000 cGy) ≤57% | |
| V (≥4000 cGy) ≤38% | |
| V (≥5000 cGy) ≤22% | |
| V (≥6000 cGy) ≤1%† | |
| Bladder‡ | V (≥4000 cGy) ≤50% |
| V (≥4800 cGy) ≤25% | |
| V (≥5680 cGy) ≤5% | |
| V (≥6000 cGy) ≤3 % | |
| Femur_L | V (≥3500 cGy) ≤5% |
| Dmax ≤3700 cGy | |
| Femur_R | V (≥3500 cGy) ≤5% |
| Dmax ≤3700 cGy | |
| Colon | Dmax ≤5000 cGy |
| Small bowel (bowel loops) | Dmax ≤4000 cGy |
| V (≥3700 cGy) ≤90 cm3 | |
| V (≥3300 cGy) ≤130 cm3 | |
| Pubic bone | V (≥5700 cGy) ≤20% |
| Penile bulb (25) | V (≥2200 cGy) ≤50% |
Abbreviation: PTV = planning target volume.
*
Safety and efficacy of hypofractionation to pelvic nodes is currently the subject of ongoing investigation and has not been established.
†
Group consensus constraint.
‡
Patient reported quality of life data for the bladder constraints is the subject of ongoing investigation.