CORE STUFF Flashcards
T1 esophagus
Invades mucosa or submucosa
T2 esophagus
Invades muscularis propria
T3 esophagus
Invades adventitia (through muscularis)
T4 esophagus
Invades adjacent structures
T4a is resectable (pleura, pericardium, diaphragm)
T4b is unresectable (aorta, trachea, vertebral body)
N1 esophagus
1-2 nodes
N2 esophagus
3-6 nodes
N3 esophagus
7+ nodes
CNS: lens
Standard fractionation
5-7 Gy MPD
CNS: retina
standard fractionation
45 MPD
CNS: optic nerve
Conventional fx
54 Gy MPD
CNS: optic chiasm
conventional
54 Gy MPD
CNS: brainstem
conventional
54 Gy MPD
Accept MPD of 60 if disease involved
CNS: cochlea
conventional
Mean <35 Gy
Accept mean <45 Gy if temporal, counsel on risk of mastoid effusion and hearing loss
CNS: cord
conventional
45 Gy MPD
Pediatric chiasm/optic constraint
50.4 MPD
CNS: lens
SRS
1 Gy
CNS: optic nerve
SRS
8 Gy MPD
CNS: chiasm
SRS
8 Gy MPD
CNS: brainstem
SRS
<12 Gy MPD
If disease involved, limit brainstem dose to 1 cc
CNS: cochlea
SRS
Mean < 4 Gy
MPD < 12 Gy
CNS: cord
MPD
14 Gy MPD
10 Gy D0.35 cc
10 Gy transection
10 Gy if prior RT
CNS: optic nerve
3fx SRS
18 Gy MPD
CNS: chiasm
3 fx SRS
18 Gy MPD
CNS: brainstem
3 fx SRS
D05% 27 Gy
CNS: cochlea
3 fx SRS
15 Gy MPD
CNS: optic nerve
5 fx SRS
Accept 5Gy x 5 MPD
but try for MPD < 23 Gy
CNS: optic chiasm
5 fx SRS
5 x 5 MPD
but try for <23
CNS: brainstem
5 fx SRS
MPD of 30 Gy
CNS: spinal cord
5 fx SRS
30 Gy MPD
If prior RT - 10 Gy MPD
HN: optics
54 MPD
HN brainstem
MPD 54
HN cord
MPD 45
HN cochlea
Mean < 35
Accept < MPD 45
HN: parotids
ALARA but Mean < 26
A least one parotid with D50 < 30 Gy
HN: larynx
Mean < 40 Gy
HN: Constrictors
Mean < 50 Gy
HN: esophagus
Mean < 34 Gy
HN: oral cavity
Mean < 30 Gy
HN: Mandible
MPD < 70
HN: lips
Mean < 20 Gy
HN: temporal lobe
MPD < 60
HN: lens
MPD < 7 Gy
HN: cornea
MPD 40 Gy
HN: retina
MPD 45 Gy
HN: globe of eye
MPD 50 Gy
Breast: Ipsi lung
Tangents
at most 2 cm of lung in tangent field
V20 < 15%
Breast: ipsilateral lung
High tangents
V20 < 20%
Breast: contralateral lung
tangents
V5 < 10%
Breast: Heart
Tangents
Mean < 1-2 Gy (if left sided)
Ideally < 0 or minimal if right sided
Breast hotspot goal
hypofractionation
MPD <107%
V105% < 10%
Breast: contralateral breast
tangents
MPD 3 Gy
Breast: ipsilateral lung
RNI
V20 < 35%
Breast: Heart
RNI
Ideally mean < 4 Gy
V20 < 5%
Accept mean dose of 5 Gy if treating IMNs
Breast: Breast hotspot
RNI
<110%
Lung: Spinal cord
Conventional
<45 Gy MPD
Lung: spinal cord
45 Gy BID regimen
41 Gy MPD
Lung: esophagus
conventional
Mean < 34 Gy
V60 < 17%
Lung: brachial plexus
conventional
66 Gy MPD
Lung: heart
conventional
V50 < 25%
V30 < 50%
Mean < 20 Gy
Lung: lung
how is this defined?
Bilateral lungs minus GTV
Lung: lung
conventional - two lungs
V20 < 35%
Mean < 20
Lung: lung
conventional post pneumonectomy
V20 < 5%
Mean < 8 Gy
Lung: kidneys
Conventional
V18 < 33%
Mean to both kidneys of 18 Gy
Lung: liver
conventional
Mean < 30
Lung: lung constraint for solitary lung
V20 < 5%
Mean < 8 Gy
Lung: spinal cord
3 FX SBRT
18 Gy MPD
Lung: esophagus
3 FX SBRT
27 Gy MPD
Lung: brachial plexus
3 FX SBRT
24 Gy MPD
Lung: heart
3 FX SBRT
30 Gy MPD
Lung: trachea and PBT
3 FX
MPD < 30 Gy
Lung: chest wall
3 FX SBRT
V30 < 30 cc
Lung: lung
3 FX SBRT
V20 < 10% (bilateral)
V20 < 25% (ipsilateral)
Lung: spinal cord
5 FX SBRT
MPD < 30 Gy
Lung: Esophagus
5 FX SBRT
<105% mpd
5 cc < 28
Lung: brachial plexus
5 FX SBRT
32 Gy MPD
Lung: heart
5 FX SBRT
<105 % MPD
Lung: trachea + PBT
5 FX SBRT
<105% MPD
Lung: lung
5 FX SBRT
V20 < 10% (bilateral)
V20 < 25% (ipsilateral)
Lung: chest wall
5 FX SBRT
V30 < 30 cc
Accept < 50 cc if compromising coverage
Lung: cord
8 FX SBRT
MPD of 30 Gy
Lung: esophagus
8 FX SBRT
MPD of 32-40 Gy
Lung: brachial plexus
8FX SBRT
40 Gy MPD
Lung: heart
8 FX SBRT
< 60 Gy MPD
Lung: great vessels
8 FX SBRT
<105%
Lung: trachea + PBT
8 FX SBRT
55 Gy MPD
Lung: lung
8 FX SBRT
V20 < 10-12% (bilateral)
V20 < 30% (ipsilateral)
Lung: spinal cord
15 FX
MPD < 40
Lung: esophagus
15 FX
MPD < 60
Mean < 28
Lung: heart
15 FX
MPD < 60
V45 < 30%
Lung: trachea and PBT
15 FX
hot spots out
Lung: liver
15 FX
700cc < 24 gy
Lymphoma: lacrimal gland
D50 < 35 Gy
Lymphoma: salivary glands
Mean < 11 Gy
Lymphoma: thyroid
V25 < 60%
Lymphoma: lung (volumetric)
V20 < 20% (ideal) accept up to <35%
V5 <35% (ideal) accept up to 55%
Lymphoma: lung (mean)
<8 ideal
up to 15 ok
Lymphoma: heart (volumetric)
V30 < 15% (accept up to 20%)
keep hot spots out of LV and coronaries
Lymphoma: heart (mean)
< 5 Gy (ideal)
ok up to 15 Gy
Lymphoma: bone marrow
Minimize low dose to avoid cytopenias (watch V5, V10)
Lymphoma: Breast
Mean < 4 Gy (ideal)
Accept up to 15 Gy
GI - cord
MPD 45 Gy
GI: lung
V20 < 20%
Mean < 20 Gy
GI: heart
V30 < 30%
Mean < 20 Gy
GI bowel MPD
55 Gy
GI bowel volumetric
V45 < 40-195 cc
GI bowel anal cancer
V45 < 20 cc (due to mitomycin)
GI: esophagus mean
< 34 Gy
GI: esophagus volumetric
V60 < 17%
GI: esophagus MPD
< 65 Gy
GI: stomach
Mean < 30 Gy
MPD < 54 Gy
GI: kidney
Mean < 18 Gy
V18 < 33%
GI: bladder volumetric
V40 < 40%
V45 < 15%
GI: bladder MPD
<50 Gy
GI: femoral head
V40 < 40%
MPD 50 Gy
GI: genitalia
V20 < 50%
MPD 40 Gy
GI: kidney (assuming 1 kidney)
V18 < 10%
Liver SBRT: cord
MPD 25 Gy
(cord + 5 mm)
Liver SBRT: bowel
MPD 30 Gy
Liver SBRT: esophagus
MPD 30 Gy
Liver SBRT: stomach
MPD 30 Gy
Liver SBRT: liver
at least 700 cc receiving <15 Gy
Liver SBRT: bile duct
MPD < 55 Gy
Liver SBRT: kidney
Ideally bilateral mean < 10 Gy
Each V15 < 67%
GI: small bowel
15 FX
MPD < 40 Gy
V37 < 40 cc
GI: large bowel
15 FX
< 50 Gy
GI: liver volumetric
15 FX
700 cc < 24 Gy
GI: liver mean
15 FX
< 24 Gy
GI: kidneys
15 FX
V20 < 33%
GYN: Small bowel
V45 < 195cc
V40 < 30%
V55 < 15 cc
GYN: rectum
V40 < 80%
GYN: bladder
V40 < 40%
V45 < 35%
GYN: femoral heads
MPD < 50 Gy
V40 < 35%
GYN: transposed ovary
< 8 Gy
GYN BRACHY: bowel [EQD2]
D2cc < 65 (accept 75)
GYN BRACHY: rectum [EQD2]
D2cc < 65 (accept 75)
GYN BRACHY: bladder [EQD2]
D2cc < 80 (accept 90)
GYN BRACHY: vagina [EQD2]
Upper vagina < 120
Mid vagina < 80
Lower vagina < 60
GYN brachy alone - rectum
2 cc < 75% prescribed dose
Gyn brachy alone - bladder
2cc roughly < 75% prescribed dose
Gyn brachy alone - vagina
120-150%
GU: rectum
conventional
V75 < 15%
V65 < 35%
V40 < 55%
GU: bladder
conventional
V80 < 15%
V75 < 25%
V65 < 50%
V40 < 70%
GU: penile bulb
conventional
V50 < 50%
GU: bowel
conventional
V45 < 200cc
MPD < 54 Gy
GU: femoral heads
MPD 50 Gy
GU: kidney
testicular
D50% < 8 Gy
GU: rectum
brachy
V100% < 1 cc
GU: urethra
brachy
Dmax < 150%
GU: rectum
mod hypo
V45 < 45%
V65 < 15% or <10 cc
GU: bladder
mod hypo
V45 < 45%
V65 < 15%
GU: penile bulb
mod hypo
ALARA
GU: bowel
mod hypo
V46 < 2cc
MPD 52
Peds: cochlea
Mean < 35
Peds brainstem
<50.4
Peds breasts
Mean < 3 Gy
Peds lung
V20 < 30%
Peds ovaries
Mean < 4-6 Gy
Peds liver
Whole liver < 23.4 Gy
V9 < 50%
Peds ipsi kidney
V19.8 < 50%
V14.4 < 100%
Peds contra kidney
V8 < 50%
Sarcoma skin strip
V20 < 50%
Sarcoma femoral neck
V60 < 5%
Femur mea < 37
Sarcoma joint
V50 < 50%
Sarcoma anus/vulva
V30 < 50%
Sarcoma testis
V3 < 50%
Spine SBRT - cord
1 fx
Dmax 14
D0.35 cc 10
Spine SBRT - cord 3 fx
MPD < 18 Gy
Spine SBRT - cord
5 FX
MPD < 30 Gy
Spine SBRT cauda
16 Gy MPD
Spine SBRT cauda
3 FX
24 Gy
Spine SBRT cauda
5 FX
32 Gy
Rectum 5 FX Dmax
28 Gy
Rectum 5 FX bladder
V25 < 65 cc
Rectum 5FX femoral heads
Dmax < 28
GU Brachy
Coverage goals
V100% > 95%
V150% < 40%
V200% < 20%
GU brachy D90 goal
>100% ideal
>90% acceptable
GU brachy
urethra
Dmax < 150%
check for 150% IDL in urethra
GU brachy
rectum
V100% < 1 cc
When to bring GU brachy patient back for dosimetry
CT at 30 days
Shoot for V100 > 90%
