2.0 3feacddc-1612-4f89-b772-0bf4259818eb *AOS_Head and Neck_Nasopharynx 70/59.4/54Gy 33fx SIB v1 Head and Neck Nasopharynx *AOS_Head and Neck_Nasopharynx 70/59.4/54Gy 33fx SIB AOS sample template - to be copied, reviewed, modified as deemed appropriate, and approved by site physicist Summary: 33fx Nasopharynx Bilateral Neck + Nodes to 70/59.4/54Gy Reference: RTOG 0615 "A Phase II Study of concurrent Chemoradiotherapy Using Three-Dimensional Conformal Radiotherapy (3D-CRT) or Intensity-Modulated Radiation Therapy (IMRT) + Bevacizumab (BV) for Locally or Regionally Advanced Nasopharyngeal Cancer" Version 1.3 Created: 10/12/2024 Last updated: 04/11/2025 ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Rx: "PTV70 (CTV70 + margin) will receive 70 Gy in 33 fractions at 2.12 Gy per fraction. PTV59.4 (CTV59.4 + margin) will receive 59.4 Gy in 33 fractions at 1.8 Gy per fraction. At the discretion of the treating physician, the dose to the high-risk subclinical region will be 59.4 Gy. If the treating physician would like to treat all sites: primary, upper and lower neck with a single...plan, the low neck will receive 54 Gy at 1.64 Gy per fraction. This is known as PTV54 (CTV54 + margin)." - RTOG 0615 "However, if there are gross nodes in the low neck, the surrounding subclinical region will receive 59.4 Gy in this case, as it is still considered high risk due to the presence of neighboring gross nodes. In addition, at the discretion of the treating physician, small volume lymph nodes can receive 63 Gy in 33 fractions at 1.9 Gy per fraction instead of 70 Gy in 33 fractions at 2.12 Gy per fraction (see Section 6.1.4)." - RTOG 0615 "The reported doses for PTV70, PTV63, PTV59.4, and PTV54 shall include the prescription dose (Sections 6.1.1-6.1.2) as well as the maximum point dose for that PTV, % PTV receiving > 110% and = 115% for that PTV and the PTV receiving < 93% of the prescribed dose for that (Sections 6.1.1-6.1.2) as well as the maximum point dose for that PTV, % PTV receiving > 110% and = 115% for that PTV and the PTV receiving < 93% of the prescribed dose for that PTV, and the mean dose for that PTV." - RTOG 0615 Normalization: "All plans shall be normalized such that at least 95% of the volume of PTV70 is covered by the 70 Gy isodose surface." - RTOG 0615 "To avoid a minor variation: - No less than 20% of PTV70 will receive = 77 Gy and no more than 5% of PTV70 will receive = 80.5 Gy. - No more than 1% of any distinct PTV should receive = 93% of the prescribed dose." - RTOG 0615 Target Contouring: "The definition of volumes will be in accordance with the 1993 ICRU Report #50: Prescribing, Recording and Reporting Photon Beam Therapy." - RTOG 0615 Target Margins: See RTOG 0615 Sections 6.4.2 and 6.4.3 for further target contouring information. OAR Contouring and Constraints: See RTOG 0615 Section 6.5 for further OAR contouring information. "Critical normal structure constraints followed by the prescription goals are the most important planning priorities. The priorities in addressing the protocol aims and constraints will be in the following order: 1) Critical Normal Structure Constraints (Section 6.5); 2) Dose Specifications (Section 6.1); 3) Planning Goals: Salivary glands (Section 6.5.3); 4) Planning Goals: Other normal structures (Section 6.5.3)." - RTOG 0615 ** See RTOG 0615 Table 6.7.4 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 R-429EC SRT Planning target volume 4294901760 PTV_59.4 Target6 R-429EB SRT Clinical target volume 5 Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items -2 ]]> R-429EC SRT Planning target volume 4294901760 PTV_70 Target7 R-429EB SRT Clinical target volume 5 Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items -2 ]]> R-429EC SRT Planning target volume 4294901760 PTV_54 Target5 R-429EB SRT Clinical target volume 5 Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items -2 ]]> R-429E0 SRT Gross tumor volume 4286578943 GTV R-429EB SRT Clinical target volume 4280918220 CTV_54 R-429EB SRT Clinical target volume 4280918220 CTV_59.4 R-429EB SRT Clinical target volume 4280918220 CTV_70 PRV 99VMS_STRUCTCODE 1.0 Planning organ-at-risk volume 4278190208 Brainstem_PRV01 OAR14 79876 FMA 3.2 Brainstem 1 ]]> 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 4278205952 OpticNrv_PRV01_L OAR24 50878 FMA 3.2 Optic nerve left 1 ]]> PRV 99VMS_STRUCTCODE 1.0 Planning organ-at-risk volume 4292290727 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 1.8 DoseVolume ShouldBeMoreOrEqual 95 Relative 59.4 Absolute DoseVolume ShouldBeMoreOrEqual 95 Relative 55.2 Absolute 2 1 DoseVolume ShouldBeMoreOrEqual 99 Relative 55.2 Absolute 2 2 VolumeDose ShouldBeLessOrEqual 20 Relative 77 Absolute VolumeDose ShouldBeLessOrEqual 40 Relative 77 Absolute 4 2 VolumeDose ShouldBeLessOrEqual 5 Relative 80 Absolute VolumeDose ShouldBeLessOrEqual 20 Relative 80 Absolute 2 3 Target2 2.12 VolumeDose ShouldBeMoreOrEqual 95 Relative 70 Absolute 1 1 VolumeDose ShouldBeMoreOrEqual 99 Relative 65 Absolute VolumeDose ShouldBeMoreOrEqual 97 Relative 65 Absolute 2 4 VolumeDose ShouldBeLessOrEqual 20 Relative 77 Absolute VolumeDose ShouldBeLessOrEqual 40 Relative 77 Absolute 4 1 VolumeDose ShouldBeLessOrEqual 5 Relative 80 Absolute VolumeDose ShouldBeLessOrEqual 20 Relative 80 Absolute 2 5 MeanDose ShouldBeLessOrEqual 74 Absolute MeanDose ShouldBeLessOrEqual 76 Absolute 2 6 Target3 1.64 DoseVolume ShouldBeMoreOrEqual 95 Relative 54 Absolute DoseVolume ShouldBeMoreOrEqual 95 Relative 50 Absolute 2 7 DoseVolume ShouldBeMoreOrEqual 99 Relative 50 Absolute 2 8 VolumeDose ShouldBeLessOrEqual 20 Relative 65 Absolute VolumeDose ShouldBeLessOrEqual 40 Relative 65 Absolute 4 3 VolumeDose ShouldBeLessOrEqual 5 Relative 68.5 Absolute VolumeDose ShouldBeLessOrEqual 20 Relative 68.5 Absolute 2 9 OAR1 MeanDose ShouldBeLessOrEqual 40 Absolute 3 14 OAR2 VolumeDose ShouldBeLess 1 Absolute 75 Absolute 3 2 OAR2 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 70 Absolute 3 1 OAR3 MeanDose ShouldBeLess 26 Absolute 2 11 OAR4 MeanDose ShouldBeLess 26 Absolute 2 10 OAR6 DoseVolume ShouldBeLess 20 Absolute 20 Absolute 2 12 OAR7 VolumeDose ShouldBeLess 5 Relative 55 Absolute 3 3 OAR8 VolumeDose ShouldBeLess 5 Relative 55 Absolute 3 4 OAR9 MeanDose ShouldBeLessOrEqual 45 Absolute 3 15 OAR10 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50 Absolute 3 5 OAR11 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50 Absolute 3 6 OAR12 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 10 Absolute 3 7 OAR13 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 10 Absolute 3 8 OAR14 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 54 Absolute 2 13 OAR15 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50 Absolute 2 17 OAR16 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 70 Absolute 3 9 OAR16 VolumeDose ShouldBeLess 1 Absolute 75 Absolute 3 10 OAR17 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 70 Absolute 3 11 OAR17 VolumeDose ShouldBeLess 1 Absolute 75 Absolute 3 12 OAR21 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 2 23 OAR22 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 66 Absolute 2 24 OAR23 MeanDose ShouldBeLess 45 Absolute 3 13 OAR24 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50 Absolute 2 19 OAR25 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50 Absolute 2 20 OAR26 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 45 Absolute 2 15 ControlRegion1 VolumeDose ShouldBeLess 1 Relative 60 Absolute 2 14 ControlRegion2 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 54 Absolute 2 18 ControlRegion3 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 54 Absolute 2 21 ControlRegion4 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 54 Absolute 2 22 ControlRegion5 VolumeDose ShouldBeLess 1 Relative 50 Absolute 2 16 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