OARs Flashcards by Kat P

Optic nerve and chiasm

QART DMax <54Gy
DMax 50Gy
TD5/5 Enami 50Gy (“Near zero risk” Quantec.
55-60 Gy 3-7% of blindness
>60Gy 7-20% risk blindness

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cochlear
(with cisP)

DMax 35Gy
DMean 35Gy

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Brainstem

Brain protocol
Max to 1cc </= 54Gy

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Rectum V50
Rectum D Mean

D Mean <35Gy (between Duo and liver)

Emami
Endpoint: severe proctitis, necrosis, fistula, stenosis
TD 5/5 60 Gy

Endpoint: RTOG Grade 2 and 3 complications
QUANTEC
Suggested conservative constraints for prescriptions up to 78 Gy (conventional fractionation) to limit Grade ≥2 complications to <15% and Grade ≥3 complications to <10% are:

V50Gy <50%
V50 </= 50% mandatory (55/20 bladder protocol)

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Fem heads
TD 5/5
DMean sarcoma prot.

TD5/5 necrosis or NOF #
<52Gy

Sarcoma prot example: Femoral Head/Neck DMean < 40Gy

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V30 small and large bowel
IGNORE

200cm3 (anal protocol)

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D50% (optimal) Anal prot
Bladder
Fem heads
Ext genetalia
IGNORE

Bladder <35Gy
Fem heads <30Gy
Ext gen <25Gy

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Normal tissue limb corridor V20Gy

<50% (mand)

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Lung cut offs for <20% risk of pneumonitis?
TD5/5 pneumonitis

Aim for mean to i/l lung in breast prot

V20 </= 30-35 %
Mean lung </= 20-23
TD5/5 3/3 lung 17.5gy

Breast prot aim I/L lung mean <6Gy

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Stomach D0.1cc (DMax) panc prot
and TD 5/5

D0.1cc panc prot mand </=54Gy
Td5/5 50gy 3/3 ulcer/perf

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TD 5/5 stomach, sm. intest, liver, kidney plus mean
Dmean spleen

Extra colon and rectum TD 5/5

Stomach ulcer/perf 50gy
Sm int obst, perf, fistula 40gy
Liver 3/3 liver failure 30gy
Kidney3/3 nephritis 23gy
Kidney mean <18 Gy
D mean spleen <10gy

Extra TD 5/5 3/3
colon 45Gy
rectum 60Gy

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Pituitary d max

<50gy

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Weight-baring bone, whole bone
DMean
And femo head/neck sarcoma prot

</= 40 gy (optimal sarcoma prot)

Sarcoma prot example: Femoral Head/Neck DMean optimal < 40Gy

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Inferior constrictors

<50gy (dars trial) leads to better swallow

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Cauda equina
Brachial plexus

TD 5/5 clinically apparent nerve damage 60gy

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Dmax for <1% risk myelopathy
Quantec 0.2% risk of myelopathy.

% recovery 6m after 1st treatment.
Spinal cord TD 5/5 myelitis/necrosis

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Dmax 46Gy
QUANTEC
Endpoint: myelopathy
To full cord cross-section 0.2% risk 50 Gy

After re-irradiation, spinal cord tolerance recovers at least 25% at 6 months after first treatment. No myelopathy seen at cumulative doses of < 60 Gy EQD2.

20cm 47Gy

DMean larynx

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<44gy (h&n QART)

Liver DMean
V30Gy
TD 5/5 liver failure 3/3

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D Mean < 30gy —> 5% risk of RILD in normal liver
V30Gy <30%
TD5/5 = 30Gy

Heart
V25
TD5/5 pericarditis
V30 (lung prot)
D mean whole heart oesophageal (mand), mediastinal lymphoma, standard lymphoma, IMN RT, Left breast

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V25 < 10% (2Gy/#) = conservative risk of <1% mortality at 5 years.
Heart TD5/5 pericarditis 40Gy

V30 (lung prot) approx <36%
D mean whole heart
oesophageal (mand) <30Gy,
mediastinal lymphoma <15Gy
standard lymphoma <5Gy
IMN RT <6Gy
Left breast <2Gy (Mand in WART) RCR consens states > 90% pts should meet this