2.0 33598e09-219e-4183-89fc-1d3d57991dc0 *AOS_Head and Neck_Oropharynx 70/56/52.5Gy 35fx SIB v1 Head and Neck Oropharynx Bilateral *AOS_Head and Neck_Oropharynx 70/56/52.5Gy 35fx SIB AOS sample template - to be copied, reviewed, modified as deemed appropriate, and approved by site physicist Summary: 35fx Oropharynx Bilateral Neck + Nodes to 70/56/52.5Gy References: RTOG 1016 "Phase III Trial of Radiotherapy Plus Cetuximab Versus Chemoradiotherapy in HPV-Associated Oropharynx Cancer" Version 1.3 Created: 10/14/2024 Last updated: 04/12/2025 (BSM) ------------------------------------------------------------------------------------------------------------------------------------------------------------------- Rx: "In this trial, dose will be slightly reduced to low risk subclinical sites (50-52.5 Gy IMRT or 44 Gy low neck anterior field) in an effort to effect a potentially modest impact in late toxicity to soft tissue and bone. IMRT will be delivered in 35 fractions over 6 weeks, 6 fractions weekly (typically, with 2 fractions one day per week at least 6 hours apart) in one plan (SIB). Concomitant boost using separate IMRT plans is not allowed. Missed treatments due to holidays or logistic reasons can be compensated for by delivering an additional BID treatment during the week, OR treating on the Saturday or Sunday of that week, OR adding to the end of treatment." - RTOG 1016 Target Volumes: "For those institutions that are using daily IGRT (see Section 6.2.2) for margin reduction, the minimum CTV-to-PTV expansion is 3.0 mm (a larger expansion may be necessary for a target volume subject to significant intrafraction variability, such as the non-immobilized oral tongue). In general, the CTV-to-PTV expansion (with IGRT) should not exceed 5 mm." - RTOG 1016 Section 6.4.1 Target Margins & Dose Specifications: *"The primary tumor and involved nodes (CTV1) will typically consist of a 0.5-1.5 cm expansion of the gross tumor volume (GTV) to cover potential local invasion and will be prescribed 2 Gy/fraction, total 70 Gy (see Section 6.1.3 for details of prescription for PTV1). *High-risk sub-clinical disease sites, which include possible local subclinical infiltration at the primary site (primary site CTV2) and first echelon nodes, which are not clinically or radiographically involved (nodal CTV2), should be expanded by 3-5 mm to create PTV2. PTV2 should receive 1.6 Gy/fraction to a total dose of 56 Gy. (This dose assumes an alpha/beta ratio of 10 Gy for tumor and 0.7 Gy loss for each day of extending treatment time beyond the time required to deliver the dose at 2 Gy/fraction; 56/1.6 over 6 weeks would result in BED2 of approximately 52 Gy). *Lower-risk targets (PTV3) (such as neck nodal levels which are not first echelon nodes and are not adjacent to levels containing grossly involved nodes) will be prescribed 50-52.5 Gy (at 1.43-1.5 Gy/fraction, BED2 = approximately 40-45 Gy)." - RTOG 1016 Normalization: *"All plans must be normalized such that 95% of the volume of the PTV1 is covered with prescription dose of 70 Gy. "Additionally: - At 1 cc PTV1 volume on the DVH curve, the dose should not be > 110% of the prescribed dose. - At a volume of 0.03 cc within the PTV1 volume on the DVH curve, the dose should not be < 95% of the prescribed dose. - For any volume of tissue outside the PTVs that has a size of 1 cc, the dose should not be > 74 Gy." - RTOG 1016 OAR Contouring and Constraints: See RTOG 1016 Section 6.4.2 for OAR contouring information. See RTOG 1016 Section 6.5.3 for OAR constraint information. "Prioritization for IMRT Planning: 1. Spinal Cord 2. Brainstem 3. PTV1 4. PTV2 (if applicable) 5. PTV3 (if applicable) 6. a. OARpharynx b. Parotid gland contralateral to primary tumor site 7. a. GSL b. Esophagus 8. a. Lips b. Oral Cavity 9. a. Parotid gland ipsilateral to primary tumor site b. Mandible 10. Unspecified tissue outside the targets." - RTOG 1016 ** See RTOG 1016 Section 6.8 for further PTV dose objectives. ** Additional OAR contraints and objectives are based on clinical judgment. ** Structures have been named according to TG 263. 20292 FMA 3.2 Oral cavity 4286595072 Cavity_Oral - PTVs 52748 FMA 3.2 Mandible 4294967295 Mandible 59797 FMA 3.2 Parotid right 4294934528 Parotid_R 59798 FMA 3.2 Parotid left 4294967168 Parotid_L 59803 FMA 3.2 Submandibular gland left 4284067071 Glnd_Submand_L 320436 FMA 3.2 Both parotids 4287760933 Parotids 60203 FMA 3.2 Left cochlea 4278223040 Cochlea_L 60202 FMA 3.2 Right cochlea 4278255360 Cochlea_R 55097 FMA 3.2 Larynx 4278206464 Larynx 12515 FMA 3.2 Eyeball left 4294967168 Eye_L 12514 FMA 3.2 Eyeball right 4280907468 Eye_R 58243 FMA 3.2 Lens left 4294967040 Lens_L 58242 FMA 3.2 Lens right 4278190335 Lens_R 79876 FMA 3.2 Brainstem 4278190080 Brainstem 62045 FMA 3.2 Optic chiasm 4291217151 OpticChiasm 54834 FMA 3.2 Temperomandibular joint left 4291597609 Joint_TM_L 54833 FMA 3.2 Temperomandibular joint right 4280918476 Joint_TM_R 7163 FMA 3.2 Skin 4290179331 Skin 72971 FMA 3.2 Temporal lobe right 4286611584 Lobe_Temporal_R 72972 FMA 3.2 Temporal lobe left 4290822336 Lobe_Temporal_L 45245 FMA 3.2 Brachial plexus left 4294934783 BrachialPlex_L 45244 FMA 3.2 Brachial plexus right 4286578943 BrachialPlex_R 7131 FMA 3.2 Esophagus 4290764055 Esophagus 50878 FMA 3.2 Optic nerve left 4278228811 OpticNrv_L 50875 FMA 3.2 Right optic nerve 4294945493 OpticNrv_R 7647 FMA 3.2 Spinal cord 4278255615 Spinal cord 59802 FMA 3.2 Submandibular gland right 4279954019 Glnd_Submand_R 59815 FMA 3.2 Lips 4294934656 Lips R-429EC SRT Planning target volume 4294901760 PTV_56 Target6 R-429EB SRT Clinical target volume 3 Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items -2 ]]> R-429EC SRT Planning target volume 4294901760 PTV_70 Target5 R-429EB SRT Clinical target volume 3 Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items -2 ]]> R-429EC SRT Planning target volume 4294901760 PTV_52.5 Target9 R-429EB SRT Clinical target volume 3 Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items -2 ]]> GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume 4285868492 GTVp R-429EB SRT Clinical target volume 4280918220 CTV_70 Target8 R-429E0 SRT Gross tumor volume 5 Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items -2 ]]> R-429EB SRT Clinical target volume 4280918220 CTVn_56 GTVn 99VMS_STRUCTCODE 1.0 Gross lymph nodes 4280891852 GTVn R-429E0 SRT Gross tumor volume 4286578943 GTV Target7 GTVn 99VMS_STRUCTCODE 1.0 Gross lymph nodes Target4 GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items -2 ]]> R-429EB SRT Clinical target volume 4280918220 CTVn_52.5 PRV 99VMS_STRUCTCODE 1.0 Planning organ-at-risk volume 4278190208 Brainstem_PRV03 OAR14 79876 FMA 3.2 Brainstem 3 ]]> PRV 99VMS_STRUCTCODE 1.0 Planning organ-at-risk volume 4286578943 OpticChiasm_PRV01 OAR15 62045 FMA 3.2 Optic chiasm 1 ]]> PRV 99VMS_STRUCTCODE 1.0 Planning organ-at-risk volume 4278222848 OpticNrv_PRV01_L OAR24 50878 FMA 3.2 Optic nerve left 1 ]]> PRV 99VMS_STRUCTCODE 1.0 Planning organ-at-risk volume 4294902015 OpticNrv_PRV01_R OAR25 50875 FMA 3.2 Right optic nerve 1 ]]> PRV 99VMS_STRUCTCODE 1.0 Planning organ-at-risk volume 4280891084 SpinalCord_PRV05 OAR26 7647 FMA 3.2 Spinal cord 5 ]]> Target1 1.6 DoseVolume ShouldBeMoreOrEqual 95 Relative 56.00000000000001 Absolute DoseVolume ShouldBeMoreOrEqual 95 Relative 45 Absolute 2 2 Target2 2 DoseVolume ShouldBeMoreOrEqual 95 Relative 70 Absolute 1 1 DoseVolume ShouldBeMoreOrEqual 99 Relative 66.5 Absolute DoseVolume ShouldBeMoreOrEqual 99 Relative 63 Absolute 2 1 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 77 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 82 Absolute 3 1 VolumeDose ShouldBeLess 1 Absolute 110.00000000000001 Relative 3 2 Target3 1.5 DoseVolume ShouldBeMoreOrEqual 95 Relative 52.5 Absolute DoseVolume ShouldBeMoreOrEqual 95 Relative 40 Absolute 2 3 OAR1 MeanDose ShouldBeLess 30 Absolute 3 16 OAR1 DoseVolume ShouldBeLess 0.03 Absolute 60 Absolute 3 17 OAR1 VolumeDose ShouldBeLess 1 Absolute 74 Absolute 4 3 OAR2 DoseVolume ShouldBeLess 0.03 Absolute 66 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 70 Absolute 3 15 OAR3 MeanDose ShouldBeLess 26 Absolute 3 3 OAR3 VolumeDose ShouldBeLess 1 Absolute 74 Absolute 3 4 OAR4 MeanDose ShouldBeLess 26 Absolute 3 5 OAR4 VolumeDose ShouldBeLess 1 Absolute 74 Absolute 3 6 OAR5 MeanDose ShouldBeLess 39 Absolute 4 8 OAR7 VolumeDose ShouldBeLess 5 Relative 55 Absolute 3 9 OAR8 VolumeDose ShouldBeLess 5 Relative 55 Absolute 3 10 OAR9 MeanDose ShouldBeLess 20 Absolute 3 11 OAR9 VolumeDose ShouldBeLess 1 Absolute 70 Absolute 4 4 OAR10 DoseVolume ShouldBeLess 0.03 Absolute 50 Absolute 3 12 OAR11 DoseVolume ShouldBeLess 0.03 Absolute 50 Absolute 3 13 OAR12 DoseVolume ShouldBeLess 0.03 Absolute 25 Absolute 3 7 OAR13 DoseVolume ShouldBeLess 0.03 Absolute 25 Absolute 3 8 OAR14 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50 Absolute 2 12 OAR15 DoseVolume ShouldBeLess 0.03 Absolute 50 Absolute 2 4 OAR16 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 70 Absolute 4 2 OAR17 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 70 Absolute 4 1 OAR21 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 60 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 2 14 OAR22 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 60 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 2 15 OAR23 MeanDose ShouldBeLessOrEqual 34 Absolute MeanDose ShouldBeLessOrEqual 40 Absolute 3 14 OAR23 VolumeDose ShouldBeLess 1 Absolute 70 Absolute 4 5 OAR24 DoseVolume ShouldBeLess 0.03 Absolute 50 Absolute 2 6 OAR25 DoseVolume ShouldBeLess 0.03 Absolute 50 Absolute 2 8 OAR26 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 45 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 47.5 Absolute 2 10 OAR27 MeanDose ShouldBeLess 39 Absolute 4 9 OAR28 MeanDose ShouldBeLess 20 Absolute 4 6 OAR28 VolumeDose ShouldBeLess 0.5 Absolute 70 Absolute 4 7 ControlRegion1 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 52 Absolute 2 13 ControlRegion2 DoseVolume ShouldBeLess 0.03 Absolute 50 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 54 Absolute 2 5 ControlRegion3 DoseVolume ShouldBeLess 0.03 Absolute 50 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 54 Absolute 2 7 ControlRegion4 DoseVolume ShouldBeLess 0.03 Absolute 50 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 54 Absolute 2 9 ControlRegion5 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50 Absolute 2 11 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 1 None 1 None 1 None 1 None 1 None 1 None 1 None