RTOG L-0117 A PHASE I/II DOSE INTENSIFICATION STUDY USING THREE
DIMENSIONAL CONFORMAL RADIATION THERAPY AND CONCURRENT CHEMOTHERAPY FOR PATIENTS WITH
INOPERABLE, NON-SMALL CELL LUNG CANCER
6.6 Normal Tissue Volume and
6.6.1 The normal organs, including skin, lungs (either as total, or contra lateral and
ipsilateral), esophagus, heart, liver, spinal cord, shall be contoured in their entirety.
6.6.2 The tolerance of the lungs
are related to the volume of the organ(s) irradiated. Data from the Washington
University2 reported that high-grade acute pneumonitis did not occur when the
V20 was < approximately 30%. The incidence and the grade or severity of pneumonitis was
clearly related to the V20. In the Washington University data, maximum dose (with
conventional fractionation) was not related to acute pneumonitis. For this protocol all
eligible patients must have the V20 < 30%.
6.6.3 The esophagus
volume (outer muscular contour) must be contoured from the level of just below the larynx
to the gastro-esophageal juncture. Oral contrast at the time of scanning is necessary to
delineate the esophagus. The percentage of the esophageal volume exceeding 55 Gy shall be < 30% and the mean esophageal dose shall
be < 34 Gy. If the esophageal dose exceeds this with the best plan possible,
then the patient should not be treated on this protocol.
6.6.4 The maximum spinal cord
(point) dose should not exceed 45 Gy.
6.6.5 Partial volume tolerance data for heart is not available. The heart dose should be
kept as low as possible. Whole heart dose should not exceed 40 Gy.
6.6.6 The liver
dose should be kept to a minimum. Half the liver should not exceed
35 Gy. The whole liver should not exceed 30 Gy.