2.0 f9976cb1-4628-4cc7-ad0a-572e976e7135 *AOS_Bladder 64Gy 32fx v1 Pelvis Bladder *AOS_Bladder 64Gy 32fx v1 AOS sample template - to be copied, reviewed, modified as deemed appropriate, and approved by site physicist Summary: 32fx Bladder to 64 Gy Reference: SWOG 1806 - "Phase III Randomized Trial of Concurrent Chemoradiotherapy with or without Atezolizumab in Localized Muscle Invasive Bladder Cancer." Version 1.0 Created: 06/09/2025 Last updated: 06/13/2025 PHH - adjusted some OAR P values ********************************************************************* Rx: "Treatment intent: Initial small pelvic fields (to treat pelvic nodes) excluded. If the bladder tumor only treatment option (option C) is chosen, then the overall schema is for 32 fractions at 2.0 Gy per day to 64 Ty to the bladder tumor only." - SWOG 1806 Dose specifications: "Covering >=95% of PTVbt." - SWOG 1806 Margins: "The definition of volumes will be in accordance with the ICRU Report #62: Prescribing, Recording, and Reporting Photon Beam Therapy. • Gross Tumor Volume (GTVbt) - Bladder Tumor. • CTV Bladder tumor (CTVbt) - The bladder gross tumor volume (GTVbt), which includes any original bladder tumor defined by TURBT, CT or other imaging modality (e.g., MRI, PET), bimanual examination, intraoperative reports and cystoscopy (surgical bladder map) constitutes this CTV. Cystoscopically placed fiducial markers may be employed. The treating radiation oncologist should consult the urologist who performed the TURBT and the resulting cystoscopy report to determine the area and size of the original tumor as seen during exam under anesthesia and TURBT. • PTV Bladder tumor (PTVbt) - The PTV will provide a margin around the CTV to compensate for the variability of treatment set up and internal organ motion. This PTV will be a direct 3-D expansion of 0.5 cm - 1 cm [for IMRT] beyond the CTVbt. Individual selection of a PTV margin should be based on the institutions’ level of confidence in patient set-up and availability of image guidance. PTV margins can be reduced from those mentioned where the PTV abuts small bowel in order to achieve small bowel constraints." - SWOG 1806 Dose deviations: * "PTV margins can be reduced from those mentioned above where the PTV abuts small bowel in order to achieve adequate PTV coverage and meet small bowel constraints. * In situations where it is challenging to meet small bowel constraints, consideration may be given to decreasing PTV margins, decreasing PTV coverage to >=90% (variation acceptable)." - SWOG 1806Treatment planning priorities: "In treatment planning, compromises are often made between getting full coverage to the PTV targets and sparing the normal structures. The following list of priorities can be used to guide how the compromises are made. The priorities are given in the order of decreasing importance. 1. Small Bowel 2. PTVbt 3. PTVwb 4. Other PTVs 5. Rectum 6. Femoral Heads" - SWOG 1806 OAR contouring: • "Rectum: The rectum is defined on CT as the entire rectal volume from its origin at the rectosigmoid flexure superiorly or the bottom of the SI joints, whichever is more inferior. The inferior extent would be to the inferior-most extent of the ischial tuberosities. The recto-sigmoid junction/flexure can be identified on the CT scan at the level the bowel turns anteriorly, close to the inferior level of the sacroiliac joints. • Bowel loops (Bowel_Small): The contouring of small bowel loops/segments is mandated. All bowel loops/segments proximal to the recto-sigmoid junction and within 2 cm of the PTV must be delineated. The recto-sigmoid junction can be identified on the CT scan at the level the bowel turns anteriorly, close to the inferior level of the sacroiliac joints. Small Bowel loops will include the entire small bowel, and does not include cecum, ascending colon, descending colon, transverse colon and sigmoid colon. • Femoral heads (Femoral_Head_L or Femoral_Head_R): Each femoral head should be outlined down to the interface between the greater and lesser trochanter. Each femoral head should be considered separately." - SWOG 1806 Normal structure constraints and compliance criteria: See Table 7.3, pg. 54. - SWOG 1806 Structures have been named according to TG 263. 7200 FMA 3.2 Small bowel 4294934720 Bowel_Small 14544 FMA 3.2 Rectum 4286595136 Rectum 32842 FMA 3.2 Femur head & neck right 4294934528 Femur_R 32843 FMA 3.2 Femur head & neck left 4278190208 Femur_L R-429EB SRT Clinical target volume 4280918220 CTVbt R-429E0 SRT Gross tumor volume 4280900300 GTVbt R-429EC SRT Planning target volume 4294901760 PTVbt Target1 R-429EB SRT Clinical target volume 5 ]]> Target1 2 Target2 2 Target3 2 VolumeDose ShouldBeMoreOrEqual 95 Relative 100 Relative VolumeDose ShouldBeMoreOrEqual 90 Relative 100 Relative 2 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 110.00000000000001 Relative DoseVolume ShouldBeLessOrEqual 0.03 Absolute 115.00000000000001 Relative 2 OAR2 VolumeDose ShouldBeLessOrEqual 50 Relative 30 Absolute VolumeDose ShouldBeLessOrEqual 55.00000000000001 Relative 30 Absolute 3 OAR2 VolumeDose ShouldBeLessOrEqual 10 Relative 55 Absolute VolumeDose ShouldBeLessOrEqual 15 Relative 55 Absolute 3 OAR4 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 55 Absolute 4 OAR4 VolumeDose ShouldBeLessOrEqual 50 Relative 45 Absolute VolumeDose ShouldBeLessOrEqual 55.00000000000001 Relative 45 Absolute 4 OAR3 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 50 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 55 Absolute 4 OAR3 VolumeDose ShouldBeLessOrEqual 50 Relative 45 Absolute VolumeDose ShouldBeLessOrEqual 55.00000000000001 Relative 45 Absolute 4 OAR1 DoseVolume ShouldBeLessOrEqual 0.03 Absolute 55 Absolute DoseVolume ShouldBeLessOrEqual 0.03 Absolute 57.5 Absolute 3 OAR1 VolumeDose ShouldBeLessOrEqual 15 Absolute 50 Absolute VolumeDose ShouldBeLessOrEqual 20 Absolute 50 Absolute 2 OAR1 VolumeDose ShouldBeLessOrEqual 100 Absolute 45 Absolute VolumeDose ShouldBeLessOrEqual 120 Absolute 45 Absolute 2 OAR1 VolumeDose ShouldBeLessOrEqual 130 Absolute 40 Absolute VolumeDose ShouldBeLessOrEqual 150 Absolute 40 Absolute 2 OAR1 VolumeDose ShouldBeLessOrEqual 30 Relative 40 Absolute VolumeDose ShouldBeLessOrEqual 35 Relative 40 Absolute 3 OAR1 VolumeDose ShouldBeLessOrEqual 150 Absolute 30 Absolute VolumeDose ShouldBeLessOrEqual 170 Absolute 30 Absolute 3 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