Advanced TP

Parameters for clinical outcome: Brainstem

Dose (Gy), or dose/volume parameters Dmax <54 D1–10 cc < 59

Irradiation type (partial organ unless otherwise stated)

Volume segmented

Notes on dose/volume parameters

Endpoint

Rate (%)

Whole organ 3D-CRT

Permanent cranial neuropathy or necrosis Permanent cranial neuropathy or necrosis Permanent cranial neuropathy or necrosis

<5 <5

Whole organ

Whole organ

3D-CRT

Dmax <64

<5

Point dose <<1 cc

For patients with acoustic tumors

Whole organ

SRS (single fraction)

Dmax <12.5

<5

• Lack of information for dose per fraction in the 4 to 8 Gy range and so there are not affordable recommendations to be followed in the middle fractionations area • The extrapolation of LQ model to the highest doses may however be incorrect

Mayo C et al. Radiation associated brainstem injury. Int. J. Radiation Oncology Biol. Phys.,