2.0 345cd149-7e48-47fe-9961-d9b8d3da616d *AOS_Liver SBRT 50Gy 5fx v1 Abdomen Liver *AOS_Liver SBRT 50Gy 5Fx AOS sample template - to be copied, reviewed, modified as deemed appropriate, and approved by site physicist Summary: Liver SBRT 5 fx to 50 Gy References: RTOG 1112 "Randomized Phase III Study of Sorafenib versus Stereotactic Body Radiation Therapy Followed by Sorafenib in Hepatocellular Carcinoma" Version 1.3 Created: 11/1/2024 (BSM) Last updated: 4/15/2025 (PHH) - Adjusted influencer P values and sub-P ordering ************************************************************************ Rx: "The prescription dose may be 50 Gy, 45 Gy, 40 Gy, 35 Gy, 30 Gy or 27.5 Gy in 5 fractions, based on normal tissue constraints. The dose to multiple PTVs may be different. The goal is to use the highest allowable prescription dose to the primary target, while respecting normal tissue constraints. The minimal planned prescription dose to PTVs is 27.5 Gy.... The prescription isodose should encompass 95% of PTV... The prescription isodose should encompass 95% of PTV... The prescription isodose should encompass 95% of PTV... The prescription isodose should encompass 95% of PTV... A goal is that 100% of the CTV is encompassed by the prescription dose." - RTOG 1112 Margins: "A minimum PTV margin of 4 mm around each CTV is required in all directions (for example if active breathing control is used with excellent reproducibility). The maximum permitted PTV margin is 20 mm, expected to be used uncommonly. It is expected that there will be no expansion from GTV to CTV for the majority of cases... PTV margins <= 10 mm are a goal... PTVs should not be manually modified due to proximity to adjacent OARs." - RTOG 1112 OAR Contouring: "As per lung SBRT RTOG atlas, the chest wall can be autosegmented from the ipsilateral lung with a 2-cm expansion in the lateral, anterior, and posterior directions. Anteriorly and medially, it ends at the edge of the sternum. Posteriorly and medially, it stops at the edge of the vertebral body with inclusion of the spinal nerve root exit site (Kong 2012). An upper abdominal/liver atlas and lung OAR atlas (RTOG 1106), posted on https://www.nrgoncology.org/ciro-gastrointestinal, may be used as a guide for contouring. For duodenum contouring, the first and second portions must be contoured for all cases and the third and fourth portions should also be contoured if those portions receive > 10 Gy." - RTOG 1112 Structures have been named according to TG 263 and not to TRIAD (as recommended in RTOG 1112). Additional OAR Contraints: "If there is one kidney mean dose > 10Gy, remaining (or only) kidney V10Gy < 10%." -RTOG 1112 Liver-GTV dose constraints in the template correspond to an Rx dose of 50 Gy and must be updated accordingly if the Rx dose is altered (see RTOG 1112). 7197 FMA 3.2 Liver 4278214144 Liver 7200 FMA 3.2 Small bowel 4294942671 Bowel_Small 7201 FMA 3.2 Large bowel 4292175646 Bowel_Large 7204 FMA 3.2 Right kidney 4278360922 Kidney_R 7205 FMA 3.2 Left kidney 4289710078 Kidney_L 264815 FMA 3.2 Both kidneys 4291606304 Kidneys 14667 FMA 3.2 Common bile duct 4293188049 BileDuct_Common 7206 FMA 3.2 Duodenum 4282198503 Duodenum 7131 FMA 3.2 Esophagus 4289986049 Esophagus 7202 FMA 3.2 Gall bladder 4290756781 Gallbladder 7088 FMA 3.2 Heart 4294934720 Heart 10951 FMA 3.2 Inferior vena cava 4283809510 V_Venacava_I 7163 FMA 3.2 Skin 4287561116 Skin Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items 3 0 ]]> 7647 FMA 3.2 Spinal cord 4278255615 SpinalCord 7148 FMA 3.2 Stomach 4294806738 Stomach 7309 FMA 3.2 Lung right 4280918732 Lung_R 50060 FMA 3.2 Chest wall 4294948202 Chestwall GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume 4285868492 GTV R-429EB SRT Clinical target volume 4280918220 CTV Target1 GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume ]]> R-429EC SRT Planning target volume 4294901760 PTV Target2 R-429EB SRT Clinical target volume 4 ]]> PRV 99VMS_STRUCTCODE 1.0 Planning organ-at-risk volume 4280891084 SpinalCord_PRV_05 OAR14 7647 FMA 3.2 Spinal cord 5 ]]> HealthyTissue 99VMS_STRUCTCODE 1.0 Generic healthy tissue 4278246767 Liver-GTV OAR1 7197 FMA 3.2 Liver Target1 GTVp 99VMS_STRUCTCODE 1.0 Primary gross tumor volume ]]> HealthyTissue 99VMS_STRUCTCODE 1.0 Generic healthy tissue 4280929353 LungR_exp OAR16 7309 FMA 3.2 Lung right 20 0 0 0 0 0 Body BODY 99VMS_STRUCTCODE 1.0 Body plus other external items ]]> Target1 10 Target2 10 VolumeDose ShouldBeMoreOrEqual 100 Relative 50 Absolute VolumeDose ShouldBeMoreOrEqual 95 Relative 50 Absolute 2 1 Target3 10 VolumeDose ShouldBeMoreOrEqual 95 Relative 50 Absolute VolumeDose ShouldBeMoreOrEqual 90 Relative 50 Absolute 1 1 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 105 Relative DoseVolume ShouldBeLessOrEqual 0.03 Absolute 110.00000000000001 Relative 3 1 OAR9 DoseVolume ShouldBeLessOrEqual 0.5 Absolute 32 Absolute DoseVolume ShouldBeLessOrEqual 0.5 Absolute 34 Absolute 3 2 OAR9 MeanDose OAR8 DoseVolume ShouldBeLess 5 Absolute 25 Absolute 3 3 OAR8 DoseVolume ShouldBeLessOrEqual 0.5 Absolute 30 Absolute DoseVolume ShouldBeLessOrEqual 0.5 Absolute 32 Absolute 2 2 OAR8 MeanDose OAR2 DoseVolume ShouldBeLessOrEqual 0.5 Absolute 30 Absolute DoseVolume ShouldBeLessOrEqual 0.5 Absolute 32 Absolute 2 3 OAR2 DoseVolume ShouldBeLess 5 Absolute 25 Absolute 3 4 OAR2 MeanDose OAR3 DoseVolume ShouldBeLessOrEqual 0.5 Absolute 32 Absolute DoseVolume ShouldBeLessOrEqual 0.5 Absolute 34 Absolute 2 4 OAR3 MeanDose ControlRegion1 DoseVolume ShouldBeLessOrEqual 0.5 Absolute 25 Absolute DoseVolume ShouldBeLessOrEqual 0.5 Absolute 28 Absolute 2 5 OAR6 MeanDose ShouldBeLess 10 Absolute 2 6 OAR15 DoseVolume ShouldBeLess 5 Absolute 25 Absolute 3 5 OAR15 DoseVolume ShouldBeLessOrEqual 0.5 Absolute 30 Absolute DoseVolume ShouldBeLessOrEqual 0.5 Absolute 32 Absolute 2 7 OAR15 MeanDose ControlRegion2 VolumeDose ShouldBeLess 70 Relative 10 Absolute 3 10 ControlRegion2 MeanDose ShouldBeLessOrEqual 13 Absolute MeanDose ShouldBeLessOrEqual 13.2 Absolute 2 8 OAR11 DoseVolume ShouldBeLess 30 Absolute 30 Absolute 3 6 OAR11 MeanDose OAR12 DoseVolume ShouldBeLess 0.5 Absolute 60 Absolute 3 12 OAR13 DoseVolume ShouldBeLess 0.5 Absolute 32 Absolute 3 11 OAR17 DoseVolume ShouldBeLess 0.5 Absolute 50 Absolute 3 9 OAR10 DoseVolume ShouldBeLess 0.5 Absolute 55 Absolute 3 7 OAR10 MeanDose OAR7 DoseVolume ShouldBeLess 0.5 Absolute 50 Absolute 3 8 OAR7 MeanDose NoNormalization 1 None 1 None 1 None 1 None 1 None