2.0 648008c9-4332-45d4-9d5f-0be01b3d3ebc *AOS_Pancreas SBRT 40/33Gy 5fx v1 Abdomen Pancreas *AOS_Pancreas SBRT 40/33Gy 5fx AOS sample template - to be copied, reviewed, modified as deemed appropriate, and approved by site physicist Summary: 5 fx pancreas SBRT to 40/33 Gy Reference: Palta et al, "Radiation Therapy for Pancreatic Cancer: An ASTRO Clinical Practice Guideline", Practical RadOnc 2019, Alliance A021501 trial (ClinicalTrials.gov ID: NCT02839343), & HyTEC (Sem Rad Onc 2016). Version 1.3 Created: 2/11/2025 (BSM) Last updated: 4/7/2025 (PHH) Adjusted sub-order of priorities, added PTV margin rules ********************************************************************* Dose objectives are based on review of the ASTRO practice guideline (Palta et al 2019), the Alliance A021501 trial, and relevant OAR guidance from HyTEC (Sem Rad Onc 2016). Rx: "For patients with locally advanced pancreatic cancer selected for SBRT, 3300-4000 cGy in 660-800 cGy fractions is recommended." - ASTRO Practice Guidelines Margins: "With SBRT, a 2-5 mm GTV/internal target volume (ITV) to planning treatment volume expansion is used to limit the dose to the stomach and bowel, particularly the duodenum" - ASTRO Practice Guidelines * Because practive techniques vary largely across sites, his template does not include derived structure definitions. Tailor to your clinical practice. OAR Constraints: Dose constraints following ASTRO Practice Guidelines with 5 fx dose constraints as defined in TG 101. Structures have been named according to TG 263. 7148 FMA 3.2 Stomach 4294806738 Stomach 7197 FMA 3.2 Liver 4278214144 Liver 7200 FMA 3.2 Small bowel 4294942671 Bowel_Small 7204 FMA 3.2 Right kidney 4278360922 Kidney_R 7205 FMA 3.2 Left kidney 4289710078 Kidney_L 7206 FMA 3.2 Duodenum 4282198503 Duodenum 264815 FMA 3.2 Both kidneys 4291606304 Kidneys 7647 FMA 3.2 Spinal cord 4278255615 SpinalCord 7163 FMA 3.2 Skin 4287561116 Skin R-429EC SRT Planning target volume 4294901760 PTV_33 Target3 GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume 3 OAR6 7206 FMA 3.2 Duodenum 3 ]]> R-429EC SRT Planning target volume 4294901760 PTV_40 Target3 GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume 3 ]]> GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume 4285868492 GTV PRV 99VMS_STRUCTCODE 1.0 Planning organ-at-risk volume 4278227712 Skin_PRV_05 Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items 5 0 ]]> PRV 99VMS_STRUCTCODE 1.0 Planning organ-at-risk volume 4280891084 SpinalCord_PRV_05 OAR8 7647 FMA 3.2 Spinal cord 5 ]]> Target1 6.6 VolumeDose ShouldBeMoreOrEqual 95 Relative 33 Absolute 2 1 Target2 8 ConformityIndex VolumeDose ShouldBeMore 95 Relative 100 Relative 2 2 Target3 8 VolumeDose ShouldBeMore 98 Relative 100 Relative 1 1 ControlRegion1 VolumeDose ShouldBeLess 10 Absolute 36 Absolute 4 1 ControlRegion1 DoseVolume ShouldBeLess 0.03 Absolute 39.5 Absolute 4 2 OAR3 DoseVolume ShouldBeLess 9 Absolute 15 Absolute 3 4 OAR3 DoseVolume ShouldBeLess 3 Absolute 28 Absolute DoseVolume ShouldBeLessOrEqual 3 Absolute 32 Absolute 3 3 OAR3 DoseVolume ShouldBeLess 0.03 Absolute 33 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 35 Absolute 3 5 OAR3 MeanDose ControlRegion2 VolumeDose ShouldBeLess 1 Absolute 8 Absolute 2 3 ControlRegion2 DoseVolume ShouldBeLess 0.03 Absolute 30 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 33 Absolute 1 2 OAR6 DoseVolume ShouldBeLess 9 Absolute 15 Absolute 3 1 OAR6 DoseVolume ShouldBeLess 3 Absolute 20 Absolute 1 3 OAR6 DoseVolume ShouldBeLess 0.03 Absolute 32 Absolute 1 4 OAR6 MeanDose OAR7 DoseVolume ShouldBeLess 75 Relative 12 Absolute 2 8 OAR7 MeanDose OAR2 DoseVolume ShouldBeLess 50 Relative 12 Absolute 2 6 OAR2 DoseVolume ShouldBeLess 700 Absolute 21 Absolute 2 5 OAR2 MeanDose OAR1 DoseVolume ShouldBeLess 9 Absolute 15 Absolute 3 2 OAR1 DoseVolume ShouldBeLess 3 Absolute 20 Absolute 2 7 OAR1 DoseVolume ShouldBeLess 0.03 Absolute 32 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 33 Absolute 2 4 OAR1 MeanDose NoNormalization 1 None 1 None 1 None 1 None 1 None