TY - JOUR
T1 - Consideration of dose limits for organs at risk of thoracic radiotherapy
T2 - Atlas for lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus
AU - Kong, Feng Ming
AU - Ritter, Timothy
AU - Quint, Douglas J.
AU - Senan, Suresh
AU - Gaspar, Laurie E.
AU - Komaki, Ritsuko U.
AU - Hurkmans, Coen W.
AU - Timmerman, Robert
AU - Bezjak, Andrea
AU - Bradley, Jeffrey D.
AU - Movsas, Benjamin
AU - Marsh, Lon
AU - Okunieff, Paul
AU - Choy, Hak
AU - Curran, Walter J.
N1 - Funding Information:
We appreciate the support of Drs. James D. Cox and Theodore S. Lawrence and the lung steering committees of the Radiation Therapy Oncology Group, European Organization for Research and Treatment of Cancer, and Southwestern Oncology Group. We are grateful to Daniel Tatro, C.M.D., and Vicki Evans, C.M.D., for their technical assistance, and Steven Kronenberg for structure labeling of the pictures.
Funding Information:
Supported in part by National Institutes of Health Grants R21CA127057 and P01CA50827 .
PY - 2011/12/1
Y1 - 2011/12/1
N2 - Purpose: To review the dose limits and standardize the three-dimenional (3D) radiographic definition for the organs at risk (OARs) for thoracic radiotherapy (RT), including the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus. Methods and Materials: The present study was performed by representatives from the Radiation Therapy Oncology Group, European Organization for Research and Treatment of Cancer, and Soutwestern Oncology Group lung cancer committees. The dosimetric constraints of major multicenter trials of 3D-conformal RT and stereotactic body RT were reviewed and the challenges of 3D delineation of these OARs described. Using knowledge of the human anatomy and 3D radiographic correlation, draft atlases were generated by a radiation oncologist, medical physicist, dosimetrist, and radiologist from the United States and reviewed by a radiation oncologist and medical physicist from Europe. The atlases were then critically reviewed, discussed, and edited by another 10 radiation oncologists. Results: Three-dimensional descriptions of the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus are presented. Two computed tomography atlases were developed: one for the middle and lower thoracic OARs (except for the heart) and one focusing on the brachial plexus for a patient positioned supine with their arms up for thoracic RT. The dosimetric limits of the key OARs are discussed. Conclusions: We believe these atlases will allow us to define OARs with less variation and generate dosimetric data in a more consistent manner. This could help us study the effect of radiation on these OARs and guide high-quality clinical trials and individualized practice in 3D-conformal RT and stereotactic body RT.
AB - Purpose: To review the dose limits and standardize the three-dimenional (3D) radiographic definition for the organs at risk (OARs) for thoracic radiotherapy (RT), including the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus. Methods and Materials: The present study was performed by representatives from the Radiation Therapy Oncology Group, European Organization for Research and Treatment of Cancer, and Soutwestern Oncology Group lung cancer committees. The dosimetric constraints of major multicenter trials of 3D-conformal RT and stereotactic body RT were reviewed and the challenges of 3D delineation of these OARs described. Using knowledge of the human anatomy and 3D radiographic correlation, draft atlases were generated by a radiation oncologist, medical physicist, dosimetrist, and radiologist from the United States and reviewed by a radiation oncologist and medical physicist from Europe. The atlases were then critically reviewed, discussed, and edited by another 10 radiation oncologists. Results: Three-dimensional descriptions of the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus are presented. Two computed tomography atlases were developed: one for the middle and lower thoracic OARs (except for the heart) and one focusing on the brachial plexus for a patient positioned supine with their arms up for thoracic RT. The dosimetric limits of the key OARs are discussed. Conclusions: We believe these atlases will allow us to define OARs with less variation and generate dosimetric data in a more consistent manner. This could help us study the effect of radiation on these OARs and guide high-quality clinical trials and individualized practice in 3D-conformal RT and stereotactic body RT.
KW - Atlas
KW - Brachial plexus
KW - Esophagus
KW - Lung
KW - Spinal cord
UR - http://www.scopus.com/inward/record.url?scp=81855206076&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=81855206076&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2010.07.1977
DO - 10.1016/j.ijrobp.2010.07.1977
M3 - Article
C2 - 20934273
AN - SCOPUS:81855206076
SN - 0360-3016
VL - 81
SP - 1442
EP - 1457
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -