QUANTEC

Question 1

Brainstem

Answer 1

Dmax < 54Gy (<5% risk CN palsy or necrosis)
D1-10cc = 59Gy (<5% risk CN palsy or necrosis)
SRS: Dmax <12.5 Gy (<5% risk CN palsy or necrosis)

Question 2

Spinal Cord

Answer 2

Dmax=50Gy (0.2% myelopathy)
Dmax=60Gy (6% myelopathy)
Dmax=70 Gy (50% myelopathy)
SRS: Dmax=13Gy (1% myelopathy)

Question 3

Brain

Answer 3

Dmax <60 Gy (<3% symptomatic necrosis)
Dmax = 72 Gy (5% symptomatic necrosis)
Dmax = 90 Gy (10% symptomatic necrosis)
SRS: V12 < 5-10cc (<20% symptomatic necrosis)

Question 4

Pituitary

Answer 4

Mean <45 Gy (hypopit)

Question 5

Optic Nerve/Chiasm

Answer 5

Dmax <55Gy (<3% optic neuropathy)
Dmax = 55-60Gy (optic neuropathy 3-7%)
Dmax >60Gy (>7-20% optic neuropathy)
SRS: Dmax < 12 Gy (<10% optic neuropathy)

Question 6

Globe/Retina

Answer 6

Dmax =45Gy (Blindness)
Emami:
TD5/5: 45Gy
TD50/5: 65Gy

Question 7

Cochlea

Answer 7

Dmean <= 45 Gy (<30% sensory-neural hearing loss)

Question 8

Lens

Answer 8

Dmax = 10Gy (Cataract requiring intervention)
Emami:
TD5/5: 10Gy
TD50/5: 18Gy

Question 9

Lacrimal Gland

Answer 9

Mean <20Gy

Mean <34Gy (5% risk dry eye syndrome, Bhandare)

Question 10

Parotid, bilateral

Answer 10

Dmean <=25 Gy (<20% risk long term salivary function <1/4 baseline)
Dmean <= 39Gy ( risk long term salivary function <1/4 baseline)

Question 11

Parotid, Unilateral

Answer 11

Dmean <=20Gy (<20% risk long term salivary function <1/4 baseline)

Question 12

Submandibular gland

Answer 12

Bilateral mean < 25 Gy

Unilateral mean < 20Gy

Question 13

Oral Cavity

Answer 13

Dmean <50Gy (mucositis)

Question 14

Pharyngeal constrictors

Answer 14

Dmean <= 50 Gy (<20% symptomatic dysphagia and aspiration)

Question 15

Larynx

Answer 15

Dmax <66Gy (<20% risk vocal dysfxn)
Dmean <50Gy (<30% risk aspiration)
Dmean <44Gy (<20% risk edema)
V50 < 27% (<20% risk edema)

Question 16

Lips

Answer 16

Dmean <25Gy (pain)

Question 17

Mandible

Answer 17

Dmax <70Gy, or <73.5 if in PTV (Osteoradionecrosis)
Emami:
TD5/5 - 65/60/60Gy
TD50/5: 77/72/72Gy –> marked limitation of joint fxn

Question 18

Thyroid

Answer 18

Mean < 25-35 Gy (hypothyroid)
Emami (Whole gland): (clinical hypothyroid)
TD8/5 - 45Gy
TD 13/5 - 60 Gy
TD 35/5 - 70 Gy

Question 19

Brachial Plexus

Answer 19

Dmax<60-63Gy (clinically apparent neuropathy)
Emami (1/2, 2/3, 3/3) - (clinically apparent neuropathy):
TD5/5 - 62/61/60Gy
TD50/5 - 77/76/75Gy

Question 20

Cauda Equina

Answer 20

Emami (no volumes) - clinically apparent neuropathy
TD5/5 - 60 Gy
TD50/5 - 75 Gy

Question 21

Lung (-GTV)

Answer 21

V20 <=30% (can accept up to 35; <20% risk symptomatic pneumonitis)
Mean < 7, 12, 20, 24, 27Gy (5, 10, 20, 30, 40% risk symptomatic pneumonitis)
V5<60% (clinical data)

Question 22

Heart (pericardium)

Answer 22

Mean < 26 Gy (<15% risk pericarditis)

V30<46% (<15% risk pericarditis)

Question 23

Heart (whole organ)

Answer 23

V25 < 10% (<1% long term cardiac mortality)

Question 24

Esophagus

Answer 24

Mean < 34Gy (5-20% risk grade 3+ esophagitis)
V35< 50% (<30% risk grade 2+ esophagitis)
V50 < 40% (<30% risk grade 2+ esophagitis)
V70 <20% (<30% risk grade 2+ esophagitis)

Question 25

Liver (normal fxn)

Answer 25

mean <30-32 Gy (<5% RILD)

Mean <42 Gy (<50% RILD)

Question 26

Liver (child pugh A or HCC)

Answer 26

Mean < 28Gy (<5% RILD)

Mean < 36Gy (<50% RILD)

Question 27

Kidney (bilateral)

Answer 27

Mean <15-18Gy (<5% risk clinical dysfxn)
Mean < 28 Gy (<50% risk clinical dysfxn)
V12 <55% (<5% risk clinical dysfxn)
V20<32% (<5% risk clinical dysfxn)
V23<30% (<5% risk clinical dysfxn)
V28<20% (<5% risk clinical dysfxn)

Question 28

Stomach

Answer 28

D100<45Gy (<7% ulceration)