CORE STUFF Flashcards
1
Q
T1 esophagus
A
Invades mucosa or submucosa
2
Q
T2 esophagus
A
Invades muscularis propria
3
Q
T3 esophagus
A
Invades adventitia (through muscularis)
4
Q
T4 esophagus
A
Invades adjacent structures
T4a is resectable (pleura, pericardium, diaphragm)
T4b is unresectable (aorta, trachea, vertebral body)
5
Q
N1 esophagus
A
1-2 nodes
6
Q
N2 esophagus
A
3-6 nodes
7
Q
N3 esophagus
A
7+ nodes
8
Q
CNS: lens
Standard fractionation
A
5-7 Gy MPD
9
Q
CNS: retina
standard fractionation
A
45 MPD
10
Q
CNS: optic nerve
Conventional fx
A
54 Gy MPD
11
Q
CNS: optic chiasm
conventional
A
54 Gy MPD
12
Q
CNS: brainstem
conventional
A
54 Gy MPD
Accept MPD of 60 if disease involved
13
Q
CNS: cochlea
conventional
A
Mean <35 Gy
Accept mean <45 Gy if temporal, counsel on risk of mastoid effusion and hearing loss
14
Q
CNS: cord
conventional
A
45 Gy MPD
15
Q
Pediatric chiasm/optic constraint
A
50.4 MPD
16
Q
CNS: lens
SRS
A
1 Gy
17
Q
CNS: optic nerve
SRS
A
8 Gy MPD
18
Q
CNS: chiasm
SRS
A
8 Gy MPD
19
Q
CNS: brainstem
SRS
A
<12 Gy MPD
If disease involved, limit brainstem dose to 1 cc
20
Q
CNS: cochlea
SRS
A
Mean < 4 Gy
MPD < 12 Gy
21
Q
CNS: cord
MPD
A
14 Gy MPD
10 Gy D0.35 cc
10 Gy transection
10 Gy if prior RT
22
Q
CNS: optic nerve
3fx SRS
A
18 Gy MPD
23
Q
CNS: chiasm
3 fx SRS
A
18 Gy MPD
24
Q
CNS: brainstem
3 fx SRS
A
D05% 27 Gy
25
CNS: cochlea
3 fx SRS
15 Gy MPD
26
CNS: optic nerve
5 fx SRS
Accept 5Gy x 5 MPD
but try for MPD \< 23 Gy
27
CNS: optic chiasm
5 fx SRS
5 x 5 MPD
but try for \<23
28
CNS: brainstem
5 fx SRS
MPD of 30 Gy
29
CNS: spinal cord
5 fx SRS
30 Gy MPD
If prior RT - 10 Gy MPD
30
HN: optics
54 MPD
31
HN brainstem
MPD 54
32
HN cord
MPD 45
33
HN cochlea
Mean \< 35
Accept \< MPD 45
34
HN: parotids
ALARA but Mean \< 26
A least one parotid with D50 \< 30 Gy
35
HN: larynx
Mean \< 40 Gy
36
HN: Constrictors
Mean \< 50 Gy
37
HN: esophagus
Mean \< 34 Gy
38
HN: oral cavity
Mean \< 30 Gy
39
HN: Mandible
MPD \< 70
40
HN: lips
Mean \< 20 Gy
41
HN: temporal lobe
MPD \< 60
42
HN: lens
MPD \< 7 Gy
43
HN: cornea
MPD 40 Gy
44
HN: retina
MPD 45 Gy
45
HN: globe of eye
MPD 50 Gy
46
Breast: Ipsi lung
Tangents
at most 2 cm of lung in tangent field
V20 \< 15%
47
Breast: ipsilateral lung
High tangents
V20 \< 20%
48
Breast: contralateral lung
tangents
V5 \< 10%
49
Breast: Heart
Tangents
Mean \< 1-2 Gy (if left sided)
Ideally \< 0 or minimal if right sided
50
Breast hotspot goal
hypofractionation
MPD \<107%
V105% \< 10%
51
Breast: contralateral breast
tangents
MPD 3 Gy
52
Breast: ipsilateral lung
RNI
V20 \< 35%
53
Breast: Heart
RNI
Ideally mean \< 4 Gy
V20 \< 5%
Accept mean dose of 5 Gy if treating IMNs
54
Breast: Breast hotspot
RNI
\<110%
55
Lung: Spinal cord
Conventional
\<45 Gy MPD
56
Lung: spinal cord
45 Gy BID regimen
41 Gy MPD
57
Lung: esophagus
conventional
Mean \< 34 Gy
V60 \< 17%
58
Lung: brachial plexus
conventional
66 Gy MPD
59
Lung: heart
conventional
V50 \< 25%
V30 \< 50%
Mean \< 20 Gy
60
Lung: lung
how is this defined?
Bilateral lungs minus GTV
61
Lung: lung
conventional - two lungs
V20 \< 35%
Mean \< 20
62
Lung: lung
conventional post pneumonectomy
V20 \< 5%
Mean \< 8 Gy
63
Lung: kidneys
Conventional
V18 \< 33%
Mean to both kidneys of 18 Gy
64
Lung: liver
conventional
Mean \< 30
65
Lung: lung constraint for solitary lung
V20 \< 5%
Mean \< 8 Gy
66
Lung: spinal cord
3 FX SBRT
18 Gy MPD
67
Lung: esophagus
3 FX SBRT
27 Gy MPD
68
Lung: brachial plexus
3 FX SBRT
24 Gy MPD
69
Lung: heart
3 FX SBRT
30 Gy MPD
70
Lung: trachea and PBT
3 FX
MPD \< 30 Gy
71
Lung: chest wall
3 FX SBRT
V30 \< 30 cc
72
Lung: lung
3 FX SBRT
V20 \< 10% (bilateral)
V20 \< 25% (ipsilateral)
73
Lung: spinal cord
5 FX SBRT
MPD \< 30 Gy
74
Lung: Esophagus
5 FX SBRT
\<105% mpd
5 cc \< 28
75
Lung: brachial plexus
5 FX SBRT
32 Gy MPD
76
Lung: heart
5 FX SBRT
\<105 % MPD
77
Lung: trachea + PBT
5 FX SBRT
\<105% MPD
78
Lung: lung
5 FX SBRT
V20 \< 10% (bilateral)
V20 \< 25% (ipsilateral)
79
Lung: chest wall
5 FX SBRT
V30 \< 30 cc
Accept \< 50 cc if compromising coverage
80
Lung: cord
8 FX SBRT
MPD of 30 Gy
81
Lung: esophagus
8 FX SBRT
MPD of 32-40 Gy
82
Lung: brachial plexus
8FX SBRT
40 Gy MPD
83
Lung: heart
8 FX SBRT
\< 60 Gy MPD
84
Lung: great vessels
8 FX SBRT
\<105%
85
Lung: trachea + PBT
8 FX SBRT
55 Gy MPD
86
Lung: lung
8 FX SBRT
V20 \< 10-12% (bilateral)
V20 \< 30% (ipsilateral)
87
Lung: spinal cord
15 FX
MPD \< 40
88
Lung: esophagus
15 FX
MPD \< 60
Mean \< 28
89
Lung: heart
15 FX
MPD \< 60
V45 \< 30%
90
Lung: trachea and PBT
15 FX
hot spots out
91
Lung: liver
15 FX
700cc \< 24 gy
92
Lymphoma: lacrimal gland
D50 \< 35 Gy
93
Lymphoma: salivary glands
Mean \< 11 Gy
94
Lymphoma: thyroid
V25 \< 60%
95
Lymphoma: lung (volumetric)
V20 \< 20% (ideal) accept up to \<35%
V5 \<35% (ideal) accept up to 55%
96
Lymphoma: lung (mean)
\<8 ideal
up to 15 ok
97
Lymphoma: heart (volumetric)
V30 \< 15% (accept up to 20%)
keep hot spots out of LV and coronaries
98
Lymphoma: heart (mean)
\< 5 Gy (ideal)
ok up to 15 Gy
99
Lymphoma: bone marrow
Minimize low dose to avoid cytopenias (watch V5, V10)
100
Lymphoma: Breast
Mean \< 4 Gy (ideal)
Accept up to 15 Gy
101
GI - cord
MPD 45 Gy
102
GI: lung
V20 \< 20%
Mean \< 20 Gy
103
GI: heart
V30 \< 30%
Mean \< 20 Gy
104
GI bowel MPD
55 Gy
105
GI bowel volumetric
V45 \< 40-195 cc
106
GI bowel anal cancer
V45 \< 20 cc (due to mitomycin)
107
GI: esophagus mean
\< 34 Gy
108
GI: esophagus volumetric
V60 \< 17%
109
GI: esophagus MPD
\< 65 Gy
110
GI: stomach
Mean \< 30 Gy
MPD \< 54 Gy
111
GI: kidney
Mean \< 18 Gy
V18 \< 33%
112
GI: bladder volumetric
V40 \< 40%
V45 \< 15%
113
GI: bladder MPD
\<50 Gy
114
GI: femoral head
V40 \< 40%
MPD 50 Gy
115
GI: genitalia
V20 \< 50%
MPD 40 Gy
116
GI: kidney (assuming 1 kidney)
V18 \< 10%
117
Liver SBRT: cord
MPD 25 Gy
| (cord + 5 mm)
118
Liver SBRT: bowel
MPD 30 Gy
119
Liver SBRT: esophagus
MPD 30 Gy
120
Liver SBRT: stomach
MPD 30 Gy
121
Liver SBRT: liver
at least 700 cc receiving \<15 Gy
122
Liver SBRT: bile duct
MPD \< 55 Gy
123
Liver SBRT: kidney
Ideally bilateral mean \< 10 Gy
Each V15 \< 67%
124
GI: small bowel
15 FX
MPD \< 40 Gy
V37 \< 40 cc
125
GI: large bowel
15 FX
\< 50 Gy
126
GI: liver volumetric
15 FX
700 cc \< 24 Gy
127
GI: liver mean
15 FX
\< 24 Gy
128
GI: kidneys
15 FX
V20 \< 33%
129
GYN: Small bowel
V45 \< 195cc
V40 \< 30%
V55 \< 15 cc
130
GYN: rectum
V40 \< 80%
131
GYN: bladder
V40 \< 40%
V45 \< 35%
132
GYN: femoral heads
MPD \< 50 Gy
V40 \< 35%
133
GYN: transposed ovary
\< 8 Gy
134
GYN BRACHY: bowel [EQD2]
D2cc \< 65 (accept 75)
135
GYN BRACHY: rectum [EQD2]
D2cc \< 65 (accept 75)
136
GYN BRACHY: bladder [EQD2]
D2cc \< 80 (accept 90)
137
GYN BRACHY: vagina [EQD2]
Upper vagina \< 120
Mid vagina \< 80
Lower vagina \< 60
138
GYN brachy alone - rectum
2 cc \< 75% prescribed dose
139
Gyn brachy alone - bladder
2cc roughly \< 75% prescribed dose
140
Gyn brachy alone - vagina
120-150%
141
GU: rectum
conventional
V75 \< 15%
V65 \< 35%
V40 \< 55%
142
GU: bladder
conventional
V80 \< 15%
V75 \< 25%
V65 \< 50%
V40 \< 70%
143
GU: penile bulb
conventional
V50 \< 50%
144
GU: bowel
conventional
V45 \< 200cc
MPD \< 54 Gy
145
GU: femoral heads
MPD 50 Gy
146
GU: kidney
testicular
D50% \< 8 Gy
147
GU: rectum
brachy
V100% \< 1 cc
148
GU: urethra
brachy
Dmax \< 150%
149
GU: rectum
mod hypo
V45 \< 45%
V65 \< 15% or \<10 cc
150
GU: bladder
mod hypo
V45 \< 45%
V65 \< 15%
151
GU: penile bulb
mod hypo
ALARA
152
GU: bowel
mod hypo
V46 \< 2cc
MPD 52
153
Peds: cochlea
Mean \< 35
154
Peds brainstem
\<50.4
155
Peds breasts
Mean \< 3 Gy
156
Peds lung
V20 \< 30%
157
Peds ovaries
Mean \< 4-6 Gy
158
Peds liver
Whole liver \< 23.4 Gy
V9 \< 50%
159
Peds ipsi kidney
V19.8 \< 50%
V14.4 \< 100%
160
Peds contra kidney
V8 \< 50%
161
Sarcoma skin strip
V20 \< 50%
162
Sarcoma femoral neck
V60 \< 5%
Femur mea \< 37
163
Sarcoma joint
V50 \< 50%
164
Sarcoma anus/vulva
V30 \< 50%
165
Sarcoma testis
V3 \< 50%
166
Spine SBRT - cord
1 fx
Dmax 14
D0.35 cc 10
167
Spine SBRT - cord 3 fx
MPD \< 18 Gy
168
Spine SBRT - cord
5 FX
MPD \< 30 Gy
169
Spine SBRT cauda
16 Gy MPD
170
Spine SBRT cauda
3 FX
24 Gy
171
Spine SBRT cauda
5 FX
32 Gy
172
Rectum 5 FX Dmax
28 Gy
173
Rectum 5 FX bladder
V25 \< 65 cc
174
Rectum 5FX femoral heads
Dmax \< 28
175
GU Brachy
Coverage goals
V100% \> 95%
V150% \< 40%
V200% \< 20%
176
GU brachy D90 goal
\>100% ideal
\>90% acceptable
177
GU brachy
urethra
Dmax \< 150%
check for 150% IDL in urethra
178
GU brachy
rectum
V100% \< 1 cc
179
When to bring GU brachy patient back for dosimetry
CT at 30 days
Shoot for V100 \> 90%
180
