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Table 2 Organs at risk

From: Technical guidelines for head and neck cancer IMRT on behalf of the Italian association of radiation oncology - head and neck working group

OAR [ [81]] Priority Endpoint Goal Minor variation Comment
Cord PRIM 0.1 cc Dmax ≤ 44-45 Gy Dmax 46 Gy  
Cord (PRV) PRIM 0.1 cc Dmax 44–48 Gy Dmax 48–50 Gy  
Brain PRIM 1 cc Dmax 60 Gy Dmax 63 Gy  
Temporal lobes PRIM 1 cc Dmax 60 Gy Dmax 65 Gy  
Brainstem (PRV) PRIM 0.1 cc Dmax 54 Gy Dmax 60 Gy  
Chiasm (PRV) PRIM 0.1 cc Dmax 54 Gy Dmax 60 Gy  
Optic nerve (PRV) PRIM 0.1 cc Dmax 54 Gy Dmax 60 Gy  
Larynx PRIM 1 cc Dmax 73.5 Gy Dmax 77 Gy  
Mandible PRIM 1 cc Dmax 70–73.5 Gy Dmax 75–77 Gy  
Inner ear SEC D mean <50 Gy <52.5 Gy  
Larynx (without cartilaginous framework) SEC V50 <25% <30% Oedema
Larynx (supraglottis) SEC Dmax <66 Gy   Dysphonia
Larynx (whole organ) SEC Dmax <50 Gy   Aspiration
Mandible SEC V55 <20%   
Esophagus SEC 1 cc Dmax 45 Gy Dmax 55 Gy  
Parotid gland SEC V30 <50% <60% at least one
  SEC Dmean ≤26 Gy   at least one
  SEC V40 <33% (contralat)   
Upper GI mucosa (outside PTV) SEC 1 cc <30 Gy <36 Gy  
Upper GI mucosa (whole volume) SEC V66.5 Dmax 64 Gy (<3 %?) Dmax 70 Gy (<5%)  
Brachial plexus PRIM 0.1 cc Dmax 60 Gy Dmax 66 Gy SEC in selected
Thyroid Gland SEC V45 <50%   
Submandibular gl SEC Dmean <35 Gy   
Constrictor pharyngeal mm SEC Dmean <50 Gy   
Lacrimal gland PRIM Dmean 26 Gy   SEC in selected cases
Lens PRIM Dmax <4 Gy <6 Gy SEC in selected cases
Retina PRIM 0.1 cc Dmax 54 Gy Dmax 60 Gy  
Pituitary gland SEC Dmax <50 Gy   
TM joints PRIM 0.1 cc <70Gy