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Table 1 Planning objectives and dose limits for OARs associated with lung treatment when using a new dose calculation algorithm

From: Dosimetrical and radiobiological approach to manage the dosimetric shift in the transition of dose calculation algorithm in radiation oncology: how to improve high quality treatment and avoid unexpected outcomes?

Structure TCD50 (Gy) a Endpoint EUDmin (Gy)   Dose limits
Target 50 [35] −10 Control EUD = Dpr
TCP > 50%
  D95% = Dpr
V95% > 95% Dpr
OARs TD50 (Gy) a [29, 36] Endpoint EUDmax (Gy)
NTCP ≤1%
EUDmax (Gy)
NTCP ≤5%
Dose limits [37, 38]
(in 3DCRT)
Lungs 24.5 [30] 1.2 Pneumonitis 13.9 17.1 Dmean< 15–20 Gy
Lungs 30.8* [39] 1.01 Pneumonitis 17.4 21.4
Esophagus 68 [30] 18 Perforation 51.1 56.5 Dmean < 34 Gy
D2% < 69 Gy
Esophagus 51* [40] 2.27 Acute esophagitis
Grade 2–3
38.4 42.4
Heart 48 [30] 3.1 Pericarditis 32.8 37.5 Dmean < 26 Gy
D2% < 30 Gy
Spinal cord 66.5 [30] 20 Necrosis 49.9 <  55.3 D2% < 50 Gy
  1. The EUD values are corresponding to clinical objectives of NTCP ≤1% or 5%. The TCD50 was taken from Okunieff et al. The parameters TD50 and a = 1/n for tissue complications with conventional fractionation were taken from Emami or more recent publications. The symbol (*) indicates the most recent and recommended tolerance dose TD50 for esophagus; and lung with heterogeneity correction using AAA. It can be seen that dose limits as Dmean and D2% depending on OARs (serial or parallel) could be matched with EUD values and the respect of the proposed dose limits might produce NTCP ≤5%. N.B. the Dmean = 20 Gy for healthy lung leads to a NTCP ≈ 15%