Dose to sites Flashcards
(37 cards)
Skin
Temp alopaecia 10-15Gy
Faint erythema 14-16Gy
Erythema 20Gy
Dry desquimation 30Gy
Moist Desquimation 40Gy
Permanent alopecia 50Gy
Chronic Telangiectasia TD 5/5: 50Gy to 100cm^2 occurs 1-2yrs post RT
Endpoint: Gangrene, necrosis, and ulceration
55Gy to 100cm^2 leads to endpoint reaction months to years post-treatment. Smaller fields, such as 10cm^2 can tolerate up to 60-70Gy
Cartilage
70Gy causes cartilage necrosis months to years post-treatment due to vascular damage
Femoral Heads and Necks
TD 50Gy < 50% of volume can cause osteoradionecrosis years to decades after RT
Small Bowel
Enteritis 20-25Gy
Diarrhoea 25Gy
Constipation 25Gy
QUANTEC: the volume receiving 45Gy should be less than 195cc for a less than 10% chance of RTOG Grade 3+ toxicity years to months post-treatment
Endpoint: Necrosis, Perforation, and Fistula
Bladder
Cystitis, Dysuria, and increased frequency 25Gy
Endpoint: Bladder contracture and volume loss
QUANTEC: A maximum radiation dose of less than 65GY to the whole organ creates a less than 6% chance of Grade 3 late RTOG endpoint months to years post-treatment. Which is severe frequency, dysuria, severe telangiectasia, and frequent haematuria.
Rectum
Acute: 20-25Gy
Proctitis
Haematochesia
Diarrhoea
Dyschesia
Rectal Pain
QUANTEC: V50<50%, V60<35%, V65<25%
less than 10% chance of a RTOG grade 2/3 late rectal toxicity months to years post-treatment
Grade 3: Obstruction or bleeding
Endpoint: Severe proctitis, fistula, stenosis, necrosis
Anus
Acute:
Inflammation and moist desquamation of the skin
Endpoint: Chronic ulcers, loss of sphincter function, and stenosis
Penile Bulb
QUANTEC: 50Gy to 90% of the gland creates a less than 35% chance of severe erectile dysfunction months to years post-treatment
Ovaries
Acute: Persistent amenorrhea 2Gy
Endpoints: Permanent sterility 2.5Gy
Vagina
Acute:
Vaginal adhesions 10Gy
Vaginitis 30Gy
Endpoint: Ulcer, fistula, fibrosis
120Gy - upper vagina
80-90Gy mid vagina
60Gy to lower 1/3
Testes
Acute: transient aspermia 0.5Gy
Endpoint: Permanent sterility 1.5Gy
Stomach
Acute: Gastritis 10-20Gy
QUANTEC: 45Gy to the whole organ for a less than 7% chance of ulceration, mucosal erosion, and perforation months to years post-treatment
Kidneys
QUANTEC: For bilateral kidneys the volume receiving 28Gy should be less than 20% this creates less than 5% chance of clinical dysfunction months to years post-treatment
Endpoint: Nephritis and kidney failure
Liver
Acute:
Jaundice, Anorexia, and Fatigue 20-25Gy
Acute radiation hepatitis and ascites 25Gy
Endpoint:
Veno-occulsive disease
Radiation-induced liver disease for which there is a less than 5% chance of occurring 2-3 weeks post-treatment if the liver is partially irradiated to 30-32Gy
Spleen
Acute: Blood counts altered and poor immune function 30-40Gy
Oesophagus
Acute: Oesophagitis reaulting in dysphagia 20Gy
QUANTEC: A mean dose of less than 34Gy creates a 5-20% chance of RTOG Grade 3+ oesophagitis (severe dysphagia)
Endpoint:
At 55Gy there is an increased risk of stricture, ulceration/perforation, and fistula during RT or months post-treatment
Heart
Acute:
20Gy asymptomatic pericarditis
40Gy acute pericarditis
QUANTEC: When considering the whole heart the volume receiving 25Gy should be less than 10% which creates a less than 1% chance of long-term cardiac mortality
Endpoint: Late myocardial infraction and fibrosis leading to reduced output
Ribs
Endpoint:
50Gy to partial rib leads to osteoradionecrosis leading to pathologic fracture years post-treatment
Breast
Acute: radiation-induced dermatitis
Chronic: Telangiectasia
Endpoint: Fibrosis causing ulceration and atrophy causing a small hard breast, with doses up to 60GY years post-treatment
Brachial Plexus
The volume receiving 60Gy should be less than 5% to create the endpoint reaction of nerve damage leading to Brachial Plexopathy months to years post-treatment. The max dose should not exceed 66Gy with a conventional fractionation schedule
Lung
Acute: acute pneumonitis
Endpoint: Chronic radiation pneumonitis
QUANTEC: for the combined lungs a V20<_30% gives a less than 20% chance of symptomatic
Spinal Cord
Acute: Lhermitte’s syndrome 35Gy
Endpoint: Radiation-induced myelitis necrosis leading to paralysis and incontinence, C spine irradiation may cause death
QUANTEC: A maximum dose of 50Gy to a partial organ creates a less than 0.2% chance of endpoint reaction with 3D-CRT
Larynx
Acute:
Laryngitis
Dysphagia and dysphonia (hoarse voice)
Laryngeal oedema (inflammation and swelling) and voice changes 45Gy, permanent doses greater than 60Gy
Treatment:
Gargle aspirin
Lignocaine Viscus Gel
Soft foods
Ensure plus for weight loss
Nasogastric tube
P.E.G.
QUANTEC: a dose of less than 66Gy within the organ creates a less than 20% chance of vocal dysfunction months post-treatment
Endpoint: chronic laryngitis and necrosis, 70Gy causes cartilage necrosis months to years post-treatment due to vascular damage
Treatment:
Pain medication
Surgical intervention
Speech therapy
Parotid Gland
Acute: temporary xerostomia (no saliva) and increased risk of tooth decay and gum disease 10-20Gy
Treatments:
Sipper bottle of water
Artificial saliva
Soft/moist foods
Dental prior
QUANTEC:
Bilateral whole parotid glands: a mean dose of less than 25Gy for the combined parotids creates a less than 20% chance of long-term salivary function of less than 25%
Unilateral whole parotid gland: a mean dose of 20Gy for a single parotid creates a less than 20% chance of long-term salivary function in the affected parotid of less than 25%
