# Radiation Oncology/Toxicity/QUANTEC

* Front Page: Radiation Oncology | RTOG Trials | Randomized Trials
Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC)
* 2010 Red Journal Issue or ScienceDirect
* 2010 PMID 20171502 -- "Use of normal tissue complication probability models in the clinic." (Marks LB, Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S10-9.)
Conventional fractionated 3D-CRT
| Critical Structure | Volume | Dose/Volume | Max Dose | Toxicity Rate | Toxicity Endpoint |
| Brain | | | <60 Gy | <3% | Symptomatic necrosis |
| Brain | | | 72 Gy | 5% | Symptomatic necrosis |
| Brain | | | 90 Gy | 10% | Symptomatic necrosis |
| Brain stem | | | <54 Gy | <5% | Neuropathy or necrosis |
| Brain stem | D1-10 cc | <= 59 Gy | | <5% | Neuropathy or necrosis |
| Brain stem | | | <64 Gy | <5% | Neuropathy or necrosis |
| Optic nerve/chiasm | | | <55 Gy | <3% | Optic neuropathy |
| Optic nerve/chiasm | | | 55-60 Gy | 3-7% | Optic neuropathy |
| Optic nerve/chiasm | | | >60 Gy | >7-20% | Optic neuropathy |
| Spinal cord | | | 50 Gy | 0.2% | Myelopathy |
| Spinal cord | | | 60 Gy | 6% | Myelopathy |
| Spinal cord | | | 69 Gy | 50% | Myelopathy |
| Cochlea | Mean | <=45 Gy | | <30% | Sensory-neural hearing loss |
| Parotid, bilateral | Mean | <=25 Gy | | <20% | Long-term salivary function <25% |
| Parotid, bilateral | Mean | <=39 Gy | | <50% | Long-term salivary function <25% |
| Parotid, unilateral | Mean | <=20 Gy | | <20% | Long-term salivary function <25% |
| Pharyngeal constrictors | Mean | <=50 Gy | | <20% | Symptomatic dysphagia and aspiration |
| Larynx | | | <66 Gy | <20% | Vocal dysfunction |
| Larynx | Mean | <50 Gy | | <30% | Aspiration |
| Larynx | Mean | <44 Gy | | <20% | Edema |
| Larynx | V50 | <27% | | <20% | Edema |
| Lung | V20 | <=30% | | <20% | Symptomatic pneumonitis |
| Lung | Mean | 7 Gy | | 5% | Symptomatic pneumonitis |
| Lung | Mean | 13 Gy | | 10% | Symptomatic pneumonitis |
| Lung | Mean | 20 Gy | | 20% | Symptomatic pneumonitis |
| Lung | Mean | 24 Gy | | 30% | Symptomatic pneumonitis |
| Lung | Mean | 27 Gy | | 40% | Symptomatic pneumonitis |
| Esophagus | Mean | <34 Gy | | 5-20% | Grade 3+ esophagitis |
| Esophagus | V35 | <50% | | <30% | Grade 2+ esophagitis |
| Esophagus | V50 | <40% | | <30% | Grade 2+ esophagitis |
| Esophagus | V70 | <20% | | <30% | Grade 2+ esophagitis |
| Heart (Pericardium) | Mean | <26 Gy | | <15% | Pericarditis |
| Heart (Pericardium) | V30 | <46% | | <15% | Pericarditis |
| Heart | V25 | <10% | | <1% | Long term cardiac mortality |
| Liver | Mean | <30-32 Gy | | <5% | RILD (in normal liver function) |
| Liver | Mean | <42 Gy | | <50% | RILD (in normal liver function) |
| Liver | Mean | <28 Gy | | <5% | RILD (in Child-Pugh A or HCC) |
| Liver | Mean | <36 Gy | | <50% | RILD (in Child-Pugh A or HCC) |
| Kidney, bilateral | Mean | <15-18 Gy | | <5% | Clinical dysfunction |
| Kidney, bilateral | Mean | <28 Gy | | <50% | Clinical dysfunction |
| Kidney, bilateral | V12 | <55% | | <5% | Clinical dysfunction |
| Kidney, bilateral | V20 | <32% | | <5% | Clinical dysfunction |
| Kidney, bilateral | V23 | <30% | | <5% | Clinical dysfunction |
| Kidney, bilateral | V28 | <20% | | <5% | Clinical dysfunction |
| Stomach | D100 | <45 Gy | | <7% | Ulceration |
| Small bowel (individual loops) | V15 | <120 cc | | <10% | Grade 3+ toxicity |
| Small bowel (peritoneal cavity) | V45 | <195 cc | | <10% | Grade 3+ toxicity |
| Rectum | V50 | <50% | | <10% | Grade 3+ toxicity |
| Rectum | V60 | <35% | | <10% | Grade 3+ toxicity |
| Rectum | V65 | <25% | | <10% | Grade 3+ toxicity |
| Rectum | V70 | <20% | | <10% | Grade 3+ toxicity |
| Rectum | V75 | <15% | | <10% | Grade 3+ toxicity |
| Bladder (bladder cancer) | | | <65 | <6% | Grade 3+ toxicity |
| Bladder (prostate cancer) | V65 | <50% | | | Grade 3+ toxicity |
| Bladder (prostate cancer) | V70 | <35% | | | Grade 3+ toxicity |
| Bladder (prostate cancer) | V75 | <25% | | | Grade 3+ toxicity |
| Bladder (prostate cancer) | V80 | <15% | | | Grade 3+ toxicity |
| Penile bulb | Mean dose to 95% gland | <50 Gy | | <35% | Severe erectile dysfunction |
| Penile bulb | D90 | <50 Gy | | <35% | Severe erectile dysfunction |
| Penile bulb | D60-70 | <70 Gy | | <55% | Severe erectile dysfunction |
Note: The “pericardium volume” was defined as a “rind” within the previously contoured heart volumes. The manually contoured heart volumes served as the outer border, and the inner border was automatically contoured 1 cm within these same contours using the planning. The heart pericardium contours on successive axial CT slices were meshed into a 3D structure (PMID 9422572).
Stereotactic Radiosurgery (single fraction)
| Critical Structure | Volume | Dose/Volume | Max Dose | Toxicity Rate | Toxicity Endpoint |
| Brain | | V12 <5-10 cc | | <20% | Symptomatic necrosis |
| Brain stem (acoustic tumors) | | | <12.5 Gy | <5% | Neuropathy or necrosis |
| Optic nerve/chiasm | | | <12 Gy | <10% | Optic neuropathy |
| Spinal cord (single-fx) | | | 13 Gy | 1% | Myelopathy |
| Spinal cord (hypo-fx) | | | 20 Gy | 1% | Myelopathy |
| Cochlea | Prescription dose | <=14 Gy | | <25% | Sensory-neural hearing loss |
| Liver/HCC (3 fractions) | Mean | <13 Gy | | <5% | RILD |
| Liver/Mets (3 fractions) | Mean | <15 Gy | | <5% | RILD |
| Liver (3 fractions) | >700 cc | <15 Gy | | <5% | RILD |