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TABLE III. Summary of suggested dose constraints for various critical organs. Note that for serial tissues, the volume-dose constraints are given in terms of the critical maximum tissue volume that should receive a dose equal or greater than the indicated threshold dose for the given number of fractions used. For parallel tissue, the volume-dose constraints are based on a critical minimum volume of tissue that should receive a dose equal to or less than the indicated threshold dose for the given number of fractions used. One fraction Threshold dose Gy 8 Max point dose Gy a 10 9 0.5 cc 0.35 cc 1.2 cc 10 10 7 15 14 18 6 Gy/fx 18 6 Gy/fx 12.3 4.1 Gy/fx Three fractions Threshold dose Gy 15.3 5.1 Gy/fx Max point dose Gy a 17.4 5.8 Gy/fx 17.1 5.7 Gy/fx 23.1 7.7 Gy/fx 21.9 7.3 Gy/fx 23 4.6 Gy/fx 23 4.6 Gy/fx 14.5 2.9 Gy/fx Five fractions Threshold dose Gy 23 4.6 Gy/fx Max point dose Gy a 25 5 Gy/fx 25 5 Gy/fx 31 6.2 Gy/fx 30 6 Gy/fx End point Grade3 Neuritis Hearing loss Cranial neuropathy Myelitis

Serial tissue Optic pathway Cochlea Brainstem not medulla Spinal cord and medulla Spinal cord subvolume 56 mm above and below level treated per Ryu Cauda equina Sacral plexus Esophagusb Brachial plexus Heart/pericardium Great vessels Trachea and large bronchusb Bronchus-smaller airways Rib Skin Stomach Duodenumb

Max critical volume above threshold 0.2 cc

10% of subvolume 5 cc 5 cc 5 cc 3 cc 15 cc 10 cc 4 cc 0.5 cc 1 cc 30 cc 10 cc 10 cc 5 cc 10 cc 5 cc 20 cc 20 cc 15 cc 3 cc 10 cc 2/3 volume

10 14 14.4 11.9 14 16 31 10.5 12.4 22 23 11.2 11.2 9 11.9 14.3 14.3 11.4 14 14

14 16 16 15.4 17.5 22 37 20.2 13.3 30 26 12.4 12.4

18 21.9 22.5 17.7 20.4 24 39

6 Gy/fx 7.3 Gy/fx 7.5 Gy/fx 5.9 Gy/fx 6.8 Gy/fx 8 Gy/fx 13 Gy/fx

21.9 24 24 25.2 24 30 45

7.3 Gy/fx 8 Gy/fx 8 Gy/fx 8.4 Gy/fx 8 Gy/fx 10 Gy/fx 15 Gy/fx

23 4.6 Gy/fx 30 6 Gy/fx 30 6 Gy/fx 19.5 3.9 Gy/fx 27 5.4 Gy/fx 32 6.4 Gy/fx 47 9.4 Gy/fx 16.5 3.3 Gy/fx 21 4.2 Gy/fx 35 7 Gy/fx 36.5 7.3 Gy/fx 18 3.6 Gy/fx 18 3.6 Gy/fx 12.5 2.5 Gy/fx 19.5 25 25 18.3 30 3.9 Gy/fx 5 Gy/fx 5 Gy/fx 3.65 Gy/fx 6 Gy/fx

30 6 Gy/fx 32 6.4 Gy/fx 32 6.4 Gy/fx 35 7 Gy/fx 30.5 6.1 Gy/fx 38 7.6 Gy/fx 53 10.6 Gy/fx 40 8 Gy/fx 33 6.6 Gy/fx 43 8.6 Gy/fx 39.5 7.9 Gy/fx 32 6.4 Gy/fx 32 6.4 Gy/fx

Myelitis Neuritis Neuropathy Stenosis/stula Neuropathy Pericarditis Aneurysm Stenosis/stula Stenosis with atelectasis Pain or fracture Ulceration Ulceration/stula Ulceration Enteritis/ obstruction Colitis/stula Proctitis/stula Cystitis/stula Impotence Necrosis Malignant hypertension

15 5 Gy/fx 18.9 28.8 30.0 30 16.5 16.5 11.4 17.7 24 24 16.8 21.9 6.3 Gy/fx 9.6 Gy/fx 10.0 Gy/fx 10 Gy/fx 5.5 Gy/fx 5.5 Gy/fx 3.8 Gy/fx 5.9 Gy/fx 8 Gy/fx 8 Gy/fx 5.6 Gy/fx 7.3 Gy/fx

30 10 Gy/fx 23.1 7.7 Gy/fx 36.9 12.3 Gy/fx 33 11 Gy/fx 22.2 7.4 Gy/fx 22.2 7.4 Gy/fx

Jejunum/ileumb Colonb Rectumb Bladder wall Penile bulb Femoral heads right and left Renal hilum/vascular trunk

15.4 18.4 18.4 18.4 34

25.2 28.2 28.2 28.2 42

8.4 Gy/fx 9.4 Gy/fx 9.4 Gy/fx 9.4 Gy/fx 14 Gy/fx

35 7 Gy/fx 38 7.6 Gy/fx 38 7.6 Gy/fx 38 7.6 Gy/fx 50 10 Gy/fx

21.9 7.3 Gy/fx

30 6 Gy/fx

10.6

18.6 6.2 Gy/fx

23 4.6 Gy/fx

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TABLE III. One fraction Threshold dose Gy Max point dose Gy a

Continued. Three fractions Threshold dose Gy Max point dose Gy a Five fractions Threshold dose Gy Max point dose Gy a End point Grade3

Benedict et al.: Stereotactic body radiation therapy: The report of TG101

Serial tissue

Max critical volume above threshold

Parallel tissue Lung right and left Lung right and left Liver Renal cortex right and left
a b

Minimum critical volume below threshold 1500 cc 1000 cc 700 cc 200 cc

One fraction Threshold dose Max point Gy dose Gy a 7 NA-Parallel tissue 7.4 NA-Parallel tissue 9.1 NA-Parallel tissue 8.4 NA-Parallel tissue

Three fractions Max point Threshold dose Gy dose Gy a 11.6 2.9 Gy/fx NA-Parallel tissue 12.4 3.1 Gy/fx NA-Parallel tissue 19.2 4.8 Gy/fx NA-Parallel tissue 16 4 Gy/fx NA-Parallel tissue

Five fractions Max point End point Threshold dose Gy dose Gy a Grade 3 12.5 2.5 Gy/fx NA-Parallel tissue Basic lung function 13.5 2.7 Gy/fx NA-Parallel tissue Pneumonitis 21 4.2 Gy/fx NA-Parallel tissue Basic liver function Basic renal 17.5 3.5 Gy/fx NA-Parallel tissue function

Point dened as 0.035 cc or less. Avoid circumferential irradiation.

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