Consideration of dose limits for organs at risk of thoracic radiotherapy: Atlas for lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus

Feng Ming Kong, Timothy Ritter, Douglas J. Quint, Suresh Senan, Laurie E. Gaspar, Ritsuko U. Komaki, Coen W. Hurkmans, Robert Timmerman, Andrea Bezjak, Jeffrey D. Bradley, Benjamin Movsas, Lon Marsh, Paul Okunieff, Hak Choy, Walter J. Curran

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    230 Scopus citations

    Abstract

    Purpose: To review the dose limits and standardize the three-dimenional (3D) radiographic definition for the organs at risk (OARs) for thoracic radiotherapy (RT), including the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus. Methods and Materials: The present study was performed by representatives from the Radiation Therapy Oncology Group, European Organization for Research and Treatment of Cancer, and Soutwestern Oncology Group lung cancer committees. The dosimetric constraints of major multicenter trials of 3D-conformal RT and stereotactic body RT were reviewed and the challenges of 3D delineation of these OARs described. Using knowledge of the human anatomy and 3D radiographic correlation, draft atlases were generated by a radiation oncologist, medical physicist, dosimetrist, and radiologist from the United States and reviewed by a radiation oncologist and medical physicist from Europe. The atlases were then critically reviewed, discussed, and edited by another 10 radiation oncologists. Results: Three-dimensional descriptions of the lung, proximal bronchial tree, esophagus, spinal cord, ribs, and brachial plexus are presented. Two computed tomography atlases were developed: one for the middle and lower thoracic OARs (except for the heart) and one focusing on the brachial plexus for a patient positioned supine with their arms up for thoracic RT. The dosimetric limits of the key OARs are discussed. Conclusions: We believe these atlases will allow us to define OARs with less variation and generate dosimetric data in a more consistent manner. This could help us study the effect of radiation on these OARs and guide high-quality clinical trials and individualized practice in 3D-conformal RT and stereotactic body RT.

    Original languageEnglish
    Pages (from-to)1442-1457
    Number of pages16
    JournalInternational Journal of Radiation Oncology Biology Physics
    Volume81
    Issue number5
    DOIs
    StatePublished - Dec 1 2011

    Keywords

    • Atlas
    • Brachial plexus
    • Esophagus
    • Lung
    • Spinal cord

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