QUANTEC Radiation

How to use this page

The dose/volume tolerance guidance on this site comes from the original QUANTEC reviews, published as a special issue of the International Journal of Radiation Oncology Biology Physics. This page routes you to them: find the organ system, then follow it to the review that carries its metrics.

Dose/volume/outcome values are stated directly in the tables below, for every organ the QUANTEC summary table covers. They are transcribed from that one table, with its authors' own caveats reproduced verbatim above them, and each table names the review its organ belongs to and the page its rows came from.

By organ system

Dose/volume/outcome data

Every row below is transcribed from a single source — Table 1 of the QUANTEC summary paper — and carries the page it appears on. All 18 organ entries in that table are now published.

Central nervous system Head and neck Thorax Abdomen Pelvis

Central nervous system

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy) and SRS (stereotactic radiosurgery). Transcribed from Table 1, p. S15. Organ review: Lawrence YR, Li XA, El Naqa I, et al., “Radiation Dose–Volume Effects in the Brain”, S20–S27.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records the D_max <54 Gy row as “Whole organ” and the other two conventional rows as “3D-CRT”; all three are presented here as 3D-CRT (3-dimensional conformal radiotherapy). The remaining row is SRS (stereotactic radiosurgery) in the source. Transcribed from Table 1, p. S15. Organ review: Mayo C, Yorke E, Merchant TE, “Radiation Associated Brainstem Injury”, S36–S41.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy) and SRS (stereotactic radiosurgery). Transcribed from Table 1, p. S15. Organ review: Mayo C, Martel MK, Marks LB, et al., “Radiation Dose–Volume Effects of Optic Nerves and Chiasm”, S28–S35. Table 1 adds that the neuropathy cases in the 55–60 Gy range received ≥59 Gy, and excludes patients with pituitary tumours, where tolerance may be reduced.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy) and SRS (stereotactic radiosurgery). Transcribed from Table 1, p. S15. Organ review: Kirkpatrick JP, van der Kogel AJ, Schultheiss TE, “Radiation Dose–Volume Effects in the Spinal Cord”, S42–S49.

Head and neck

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy) and SRS (stereotactic radiosurgery). Transcribed from Table 1, p. S15. Organ review: Bhandare N, Jackson A, Eisbruch A, et al., “Radiation Therapy and Hearing Loss”, S50–S57.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy). Transcribed from Table 1, p. S15–S16. Organ review: Deasy JO, Moiseenko V, Marks L, et al., “Radiotherapy Dose–Volume Effects on Salivary Gland Function”, S58–S63. Table 1 notes that severe xerostomia also depends on other factors, including dose to the submandibular glands.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records this row’s irradiation type as “Whole organ”; it is presented here as 3D-CRT (3-dimensional conformal radiotherapy). Transcribed from Table 1, p. S16. Organ review: Rancati T, Schwarz M, Allen AM, et al., “Radiation Dose–Volume Effects in the Larynx and Pharynx”, S64–S69.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy). Transcribed from Table 1, p. S16. Organ review: Rancati T, Schwarz M, Allen AM, et al., “Radiation Dose–Volume Effects in the Larynx and Pharynx”, S64–S69. Table 1 attributes the edema rows to an estimate by Dr Eisbruch.

Thorax

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy). Transcribed from Table 1, p. S16. Organ review: Marks LB, Bentzen SM, Deasy JO, et al., “Radiation Dose–Volume Effects in the Lung”, S70–S76. The lung review itself notes (p. S72) that “it is likely that the MLD–RP relationship may have lower predictive power for ‘nonstandard’ dose distributions not included in these analyses, for example after stereotactic body radiotherapy (SBRT), Intensity-Modulated Radiation Therapy (IMRT), or proton therapy.” That review also states there are no evident threshold tolerance dose–volume levels for lung; the values above are points on a gradual dose response, not thresholds. Table 1 carries no V₃₀ row for lung — V₂₀ is the only Vx it gives, and it must not be read as covering V₃₀. The source states one note across all five mean-dose rows: excludes purposeful whole lung irradiation.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy). Transcribed from Table 1, p. S16. Organ review: Gagliardi G, Constine LS, Moiseenko V, et al., “Radiation Dose–Volume Effects in the Heart”, S77–S85.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy). Transcribed from Table 1, p. S16. Organ review: Werner-Wasik M, Yorke E, Deasy J, et al., “Radiation Dose–Volume Effects in the Esophagus”, S86–S93.

Abdomen

Apply with caution — these are estimates; check applicability against the organ review itself. The source records the two <5% conventional rows as “3D-CRT or Whole organ” and the two <50% conventional rows as “3D-CRT”; all four are presented here as 3D-CRT (3-dimensional conformal radiotherapy). The remaining rows are SBRT (stereotactic body radiotherapy) in the source. Rows are ordered by technique and then by number of fractions, which is not the source’s row order; no dose, rate or note has been paired differently. Transcribed from Table 1, p. S17. Organ review: Pan CC, Kavanagh BD, Dawson LA, et al., “Radiation-Associated Liver Injury”, S94–S100. The four SBRT rows are confirmed verbatim by that review, which recommends mean normal liver dose <13 Gy (primary, three fractions), <18 Gy (primary, six), <15 Gy (metastases, three) and <20 Gy (metastases, six), plus a critical-volume constraint of ≥700 mL receiving ≤15 Gy in three to five fractions.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records the three rows’ irradiation type as “Bilateral whole organ or 3D-CRT”, “Bilateral whole organ” and “3D-CRT” respectively; all three are presented here as 3D-CRT (3-dimensional conformal radiotherapy), with the bilateral whole-kidney volume carried in the caption. Transcribed from Table 1, p. S17. Organ review: Dawson LA, Kavanagh BD, Paulino AC, et al., “Radiation-Associated Kidney Injury”, S108–S115. Rows 1 and 2 are cross-confirmed by that review, which reports a threshold of 15 Gy and 5% and 50% risk at 18 Gy and 28 Gy for whole-kidney RT. Its Table 5, headed “suggested dose–volume constraints for estimated risk of <5%”, carries all four of the constraints above, each attributed to a study: V₁₂ <55% (Welz et al.), V₂₀ <32% (Jansen et al.), V₂₃ <30% and V₂₈ <20% (Nevinny-Stickel et al.). These four are not a single set. Table 5 gives each its own row under “partial kidney irradiation”, with its own investigator, and the review’s only reference to that table calls its contents “some broad guidelines” that “will hopefully be tested in future studies”, adding that “all dose–volume recommendations are associated with substantial uncertainty”. Neither Table 1 nor the review states that the four must be met together, so — unlike the rectum and bladder sets on this page — they should not be read as one conjunctive constraint.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records this row’s irradiation type as “Whole organ”; it is presented here as 3D-CRT (3-dimensional conformal radiotherapy). Transcribed from Table 1, p. S17. Organ review: Kavanagh BD, Pan CC, Dawson LA, et al., “Radiation Dose–Volume Effects in the Stomach and Small Bowel”, S101–S107. That review notes no comparable predictive model of acute toxicity is available for stomach.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy). Transcribed from Table 1, p. S17. Organ review: Kavanagh BD, Pan CC, Dawson LA, et al., “Radiation Dose–Volume Effects in the Stomach and Small Bowel”, S101–S107. Both rows are confirmed by that review: “V15 = 120 cc if individual bowel loops are outlined or V45 = 195 cc if entire peritoneal potential space of bowel is outlined”.

Pelvis

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy). Transcribed from Table 1, p. S18. Organ review: Michalski JM, Gay H, Jackson A, et al., “Radiation Dose–Volume Effects in Radiation-Induced Rectal Injury”, S123–S129. The five constraints are a single set, not independent rows: that review states they are “a conservative starting point for 3D treatment planning” and that “for typical DVHs, the NTCP models predict that following these constraints should limit Grade ≥2 late rectal toxicity to <15% and the probability of Grade ≥3 late rectal toxicity to <10% for prescriptions up to 79.2 Gy in standard 1.8- to 2-Gy fractions” — both rates are a model prediction conditional on DVH shape, not an observed outcome. It also notes the constraints have yet to be validated as relatively safe. Table 1’s own Notes cell for this row reads simply “Prostate cancer treatment”, which is carried in the caption above — so this table has no Notes column rather than an empty one, and nothing has been dropped.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy). Transcribed from Table 1, p. S18. Organ review: Viswanathan AN, Yorke ED, Marks LB, et al., “Radiation Dose–Volume Effects of the Urinary Bladder”, S116–S122. No complication rate is given for the second row, and that blank is in the source: the bladder review offers those correlates “in the absence of any reliable data”, citing the conventional-fractionation arm of RTOG 0415. Those four correlates are one constraint, not four alternatives. That review describes the trial as having “included a solid bladder constraint of” the four volumes, stating them in a single sentence joined by “and” — so, as with the rectum set above, they are met together. The kidney V_x values above are the opposite case, and are annotated as such.

Apply with caution — these are estimates; check applicability against the organ review itself. The source records these rows as 3D-CRT (3-dimensional conformal radiotherapy). Transcribed from Table 1, p. S18. Organ review: Roach M III, Nam J, Gagliardi G, et al., “Radiation Dose–Volume Effects and the Penile Bulb”, S130–S134.

NTCP Models

Normal tissue complication probability models are described in the introductory QUANTEC paper, Use of Normal Tissue Complication Probability Models in the Clinic, which presents a clinician's view on applying QUANTEC information alongside a description of the most commonly used NTCP models.

Read: Use of Normal Tissue Complication Probability Models in the Clinic