2.0 59e0f109-dd6a-4817-bce0-10864019be51 *AOS_Esophagus_Lower 50.4Gy 28fx v1 Abdomen Lower Esophagus *AOS_Esophagus_Lower 50.4Gy 28Fx AOS sample template - to be copied, reviewed, modified as deemed appropriate, and approved by site physicist Summary: Lower Esophagus 28 fx to 50.4 Gy References: RTOG 94-05 "A Phase III Intergroup Randomized Comparison of Combined Modality Therapy for Carcinoma of the Esophagus: High Dose vs Conventional Dose Radiation Therapy"; NRG Oncology GI-006, "Phase III Randomized Trial of Proton Beam Therapy (PBT) Versus Intensity Modulated Photon Radiotherapy (IMRT) for the Treatment of Esophageal Cancer" Version 1.2 Created: 2/11/2025 (PHH) Last updated: 3/10/2025 (PHH) - adjusted target P levels ************************************************************************ Rx: "The daily fraction size will be 1.8 Gy/day x 28 fractions. Arm 2 - Conventional Dose RT: The doses and techniques of RT will be identical to Arm 1 (Section 6.7.1.1) except patients will not receive the 14.4 Gy conedown (Section 6.7.1.2). Therefore, the total dose will be limited to 50.4 Gy in 28 fractions." - RTOG 94-05 PTV Margins: Modified from the RTOG 94-05 description to reduce to 1.0 cm lateral and 3.0 cm sup-inf, reflecting adaptive therapy and more modern findings regarding sup-inf esophageal variation. Tailor to your own practice CTV definition/PTV margin expansions. Tx Planning: Per GI-006 conventions for the IMRT arm. OAR Constraints: "Normal Tissue Doses: The spinal cord dose must not exceed 45 Gy maximum. Normal lung (more than 2 cm outside the target volume) must not receive more than 45 Gy. The entire heart dose should be no more than 30 Gy with < 50% of the organ receiving a maximum of 40 Gy." -RTOG 94-05 Structures have been named according to TG 263. 7088 FMA 3.2 Heart 4294957055 Heart 7131 FMA 3.2 Esophagus 4289068874 Esophagus 7148 FMA 3.2 Stomach 4294934720 Stomach 7309 FMA 3.2 Lung right 4278190284 Lung_R 7310 FMA 3.2 Lung left 4294967040 Lung_L 7647 FMA 3.2 Spinal cord 4278255615 SpinalCord 68877 FMA 3.2 Both lungs 4294934528 Lungs R-429E0 SRT Gross tumor volume 4280900300 GTV R-429EC SRT Planning target volume 4294901760 PTV Target1 R-429E0 SRT Gross tumor volume 10 0 30 10 0 30 ]]> NormalTissue 99VMS_STRUCTCODE 1.0 Unidentified structure 4280426092 Lungs-PTV OAR5 7310 FMA 3.2 Lung left OAR4 7309 FMA 3.2 Lung right Target2 R-429EC SRT Planning target volume 5 ]]> Target1 1.8 DoseVolume ShouldBeMoreOrEqual 95 Relative 100 Relative DoseVolume ShouldBeMoreOrEqual 95 Relative 95 Relative 1 1 Target2 1.8 DoseVolume ShouldBeMoreOrEqual 95 Relative 100 Relative DoseVolume ShouldBeMoreOrEqual 95 Relative 90 Relative 2 1 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 110.00000000000001 Relative DoseVolume ShouldBeLessOrEqual 0.03 Absolute 113.00000000000001 Relative 3 4 OAR1 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 53 Absolute 3 1 OAR1 DoseVolume ShouldBeLess 50 Relative 40 Absolute 3 2 OAR1 MeanDose ShouldBeLessOrEqual 20 Absolute MeanDose ShouldBeLessOrEqual 30 Absolute 2 3 OAR3 MeanDose ShouldBeLessOrEqual 40 Absolute MeanDose ShouldBeLessOrEqual 45 Absolute 3 3 OAR6 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 45 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50 Absolute 2 2 ControlRegion1 VolumeDose ShouldBeLessOrEqual 20 Relative 20 Absolute VolumeDose ShouldBeLessOrEqual 25 Relative 20 Absolute 2 4 ControlRegion1 MeanDose ShouldBeLessOrEqual 15 Absolute MeanDose ShouldBeLessOrEqual 20 Absolute 2 5 NoNormalization 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None 1 None