RADIATION THERAPY ONCOLOGY GROUP  RTOG 0529

A Phase II Evaluation of Dose-Painted IMRT in Combination with 5-Fluorouracil and Mitomycin-C for Reduction of Acute Morbidity in Carcinoma of the Anal Canal

see images : a,  b,  c, d

Target prescription dose: The prescription dose scheme shall depend on staging as follows:

For T2N0 disease: The primary tumor PTV (PTVA) will receive 50.4 Gy in 28 fractions at 1.8 Gy per fraction. The nodal PTVs will receive 42 Gy in 28 fractions at 1.5 Gy per fraction.

For T3N0 or T4N0 disease: The primary tumor PTV (PTVA) will receive 54 Gy in 30 fractions at 1.8 Gy per fraction. The nodal PTVs will receive 45 Gy in 30 fractions at 1.5 Gy per fraction.

Critical normal structures: DVHs must be generated for all critical normal structures.

The dose constraints are listed in order from most to least important.

Small bowel: No more than 200 cc above 30 Gy, No more than 150 cc above 35 Gy, No more than 20 cc above 45 Gy, None above 50 Gy

Femoral heads: No more than 50% above 30 Gy, No more than 35% above 40 Gy, No more than 5% above 44 Gy

Iliac crests: No more than 50% above 30 Gy, No more than 35% above 40 Gy, No more than 5% above 50 Gy

External genitalia:  No more than 50% above 20 Gy, No more than 35% above 30 Gy, No more than 5% above 40 Gy

Bladder: No more than 50% above 35 Gy, No more than 35% above 40 Gy, No more than 5% above 50 Gy

Large bowel: No more than 200 cc above 30 Gy, No more than 150 cc above 35 Gy, No more than 20 cc above 45 Gy