# Radiation Oncology/Toxicity/UK Consensus SRS&SBRT

* Front Page: Radiation Oncology | RTOG Trials | Randomized Trials
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 | SINGLE FRACTION | THREE (3) FRACTIONS | THREE (3) FRACTIONS | FIVE (5) 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 | THREE (3) FRACTIONS | FIVE (5) 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 |
| Kidneys (Each & Total) | D200cc | -- | 16 | -- | -- | Renal Dysfunction |
| 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 | 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 |