GOECP/SEOR radiotheraphy guidelines for non-small-cell lung cancer

Table 9 The constraints to organs at risk s in stereotactic body radiotherapy based on the studies

Organ	Single fraction (30-34 Gy)		Three fractions (54-60 Gy)		Four fractions (48 Gy)		Five fractions (50-60 Gy)		Eight fractions (60 Gy)		Ref.
	Optimal	Mandatory	Optimal	Mandatory	Optimal	Mandatory	Optimal	Mandatory	Optimal	Mandatory
Brachial plexus	14 Gy < 3 cc	17.5 Gy ≤ 0.035 cc	20.4 Gy < 3cc	24 Gy ≤ 0.035 cc			27 Gy < 3 cc	30.5 Gy ≤ 0.035 cc			Benedict et al[139], Grimm et al[140]
	14.4 Gy < 3cc	17.5 Gy Dmax	22.5 Gy < 3 cc	24 Gy			30 Gy < 3 cc	32 Gy			Bezjak et al[43]
					23.6 Gy < 3 cc, 30 Gy < 10 cc, 35 Gy < 1 cc	27.2 Gy Dmax, 40 Gy Dmax					Videtic et al[31], Chang et al[146]
			24 Gy ≤ 0.5 cc	26 Gy ≤ 0.5 cc			27 Gy ≤ 0.5 cc	29 Gy ≤ 0.5 cc	27 Gy ≤ 0.5 cc	38 Gy ≤ 0.5 cc	Hanna et al[141]
Spinal cord	10 Gy < 0.35 cc, 7 Gy < 1.2 cc	14 Gy ≤ 0.035 cc	14 Gy < 0.35 cc, 12.3 Gy < 1.2 cc	18 Gy ≤ 0.035 cc			23 Gy < 0.35 cc, 14.5 Gy < 1.2 cc	30 Gy ≤ 0.035 cc			Benedict et al[139]
	7 Gy < 1.2 cc	7 Gy < 1.2 cc	18 Gy < 0.25 cc, 11.1 Gy < 1.2 cc	18 Gy	20.8 Gy < 0.35 cc, 13.6 Gy < 1.2 cc	26 Gy Dmax	22.5 Gy < 0.25 cc, 13.5 Gy < 1.2 cc, 13.5 Gy < 0.5 cc				Bezjak et al[43], Videtic et al[31], Timmerman et al[36]
			18 Gy < 0.1 cc	21.9 Gy < 0.1 cc			23 Gy < 0.1 cc	30 Gy < 0.1 cc	25 Gy < 0.1 cc	32 Gy < 0.1 cc	Hanna et al[141]
Esophagus	11.9 Gy < 5 cc, 14.5 Gy < 5 cc	15.4 Gy Dmax	17.7 Gy < 5 cc	25.2 Gy			19.5 Gy < 5 cc	35 Gy			Videtic et al[31]
			21 Gy < 5 cc	27 Gy	18.8 Gy < 5 cc, 30 Gy < 10 cc, 35 Gy < 1 cc	30 Gy Dmax, 50 Gy Dmax	27.5 Gy < 5 cc	35 Gy, 52.5 Gy			Timmerman et al[36], Bezjak et al[43], Chang et al[146]
				25.2 Gy < 0.5 cc			32 Gy < 0.5 cc	34 Gy < 0.5 cc		40 Gy < 0.5 cc	Hanna et al[141]
Heart	16 Gy < 15 cc, 16 Gy < 15 cc	22 Gy Dmax, 22 Gy Dmax	24 Gy < 15 cc, 24 Gy < 15 cc	30 Gy Dmax, 30 Gy Dmax	28 Gy < 15 cc, 35 Gy < 10 cc, 40 Gy < 1 cc	34 Gy Dmax, 50 Gy Dmax	32 Gy < 15 cc, 32 Gy < 15 cc	38 Gy Dmax, 38 Gy Dmax, 52.5 Gy Dmax			Benedict et al[139], Timmerman et al[36], Bezjak et al[43], Chang et al[146]
			24 Gy < 0.5 cc	26 Gy < 0.5 cc			27 Gy < 0.5 cc	29 Gy < 0.5 cc	50 Gy < 0.5 cc	60 Gy	Hanna et al[141]
Great Vessels	31 Gy < 10 cc	37 Gy Dmax	39 Gy < 10 cc	45 Gy Dmax			47 Gy < 10 cc	53 Gy Dmax			Benedict et al[139]
	31 Gy < 10 cc	37 Gy < 0.035 cc	39 Gy < 10 cc	45 Gy Dmax	43 Gy < 10 cc, 35 Gy < 10 cc, 40 Gy < 1 cc	49 Gy Dmax	47 Gy < 10 cc	52.5 Gy Dmax			Bezjak et al[43], Videtic et al[31], Chang et al[146]
				45 Gy < 0.5 cc		53 Gy < 5 cc					Hanna et al[141]
Trachea and bronchus	10.5 Gy < 4 cc	20.2 Gy Dmax	15 Gy < 4 cc	30 Gy Dmax			16.5 Gy < 4 cc	40 Gy Dmax			Benedict et al[139]
	8.8 Gy < 4 cc, 10.5 Gy < 4 cc	22 Gy Dmax, 20.2 Gy < 0.035 cc	21 Gy < 5 cc	30 Gy Dmax	30 Gy < 10 cc, 35 Gy < 1 cc, 15.6 Gy < 4 cc	50 Gy Dmax, 34.8 Gy Dmax					Bezjak et al[43], Videtic et al[31], Timmerman et al[36], Chang et al[146]
			30 Gy < 0.5 cc	32 Gy < 0.5 cc			32 Gy < 0.5 cc	35 Gy < 0.5 cc	32 Gy < 0.5 cc	44 Gy < 0.5 cc	Hanna et al[141]
Skin	23 Gy < 10 cc, 14.4 Gy < 10 cc	26 Gy Dmax, 16 Gy Dmax	30 Gy < 10 cc, 22.5 Gy < 10 cc	33 Gy Dmax, 24 Gy Dmax	35 Gy < 10 cc, 40 Gy < 1 cc, 33.2 Gy < 10 cc	36 Gy Dmax	36.5 Gy < 10 cc, 30 Gy < 10 cc	39.5 Gy Dmax, 32 Gy Dmax			Benedict et al[139], Chang et al[146], Videtic et al[31]
Chest wall	22 Gy < 1 cc	30 Gy Dmax	28.8 Gy < 1 cc, 30 Gy < 30 cc	36.9 Gy Dmax			35 Gy < 1 cc	43 Gy Dmax			Benedict et al[139]
	22 Gy < 1 cc	30 Gy Dmax	30 Gy < 30 cc, 50 Gy < 2.3 cc		35 Gy < 10 cc, 32 Gy < 1 cc	40 Gy Dmax	30 Gy < 30 cc, 50 Gy < 2.3 cc, 60 Gy < 1.4 cc				Videtic et al[31], Kong et al[145], Liao et al[147]
			37 Gy < 0.5 cc, 30 Gy < 30 cc				39 Gy < 0.5 cc, 32 Gy < 30 cc		39 Gy < 0.5 cc, 35 Gy < 30 cc		Hanna et al[141], Dunlap et al[142], Ma et al[143]
			40 Gy < 5 cc, 60 Gy < 0.5 cc				V30 < 30 cc, V30 < 70 cc				Herth et al[19]
Normal lungs	Minimal critical volume under threshold. 1500 cc, 1000 cc	Threshold dose: 7 Gy, 7.4 Gy		Threshold dose: 11.6 Gy, 12.4 Gy			Threshold dose: 12.5 Gy, 13.5 Gy				Benedict et al[139]
	Minimal critical volume under threshold. 1500 cc, 1000 cc, 1500 cc, 1000 cc	7 Gy, 7.4 Gy	20 Gy < 10%, 20 Gy < 15%	10.5 Gy, 11.4 Gy	11.6 Gy, 12.4 Gy, 20 Gy < 20%, 30 Gy < 10%		12.5 Gy, 13.5 Gy, 20 Gy < 20%, 30 Gy < 10%				Bezjak et al[43], Videtic et al[31], Chang et al[146]
				V20 < 10%, V12.5 < 15%			V20 < 10%, V12.5 < 15%		V20 < 10%, V12.5 < 15%		Hanna et al[141]
	Treatment on lesion: V20 < 10%; treatment 2-3 lesions: V20 < 12.5% (optimal); V20 < 15% (acceptable); V20 < 20% (selected cases) 3-8 fractions on alternating days. If the lesions are not included in the treatment field, alternate the treatment days for the different lesions										Hanna et al[141]
	In 3-5 fraction Dmean ≤ 8 Gy and V20 ≤ 10%-15%										Kong et al[145]