General
This page documents the modifications to the scoring criteria submitted to NCI for approval. Dry runs are currently being evaluated using the criteria and it is anticipated that NCI approval will be received shortly. These criteria are being published to aid interested participants in developing protocol compliant treatment plans.
An overall score is assigned to each plan. The items involved in the scoring are the coverage and overdose of PTV66 and PTV54 and the level of parotid gland sparing. There are recommendations for maximum doses to several organs at risk (enumerated below) that the participant should strive to comply with. However, excepting the parotid glands, doses delivered to them are advisory and not regulatory in nature. The largest variation encountered (None, Minor or Major) will be the overall score assigned to the plan.
No credentialing plan (dry run) will be approved that results in a Major Variation. Plans with No Variation or Minor Variations will be approved (assuming no other significant areas of protocol non-compliance).
Some treatment planning systems have demonstrated potential problems submitting generated PTV structures. Those facilities that have problems submitting correct PTV contours should contact the ITC for assistance.
Notes About Target Volumes
GTV and PTV66
The GTV will be encompassed by a (minimum) 5 mm margin (in all three
dimensions) that will be identified as PTV66.
CTV54, CTV60 and Associated
PTV54 and PTV60
Any subclinical extension from the GTV will be contained within (at least) the
CTV54 or possibly, CTV60. Node levels in the neck at risk of subclinical disease
will be included in PTV54 or PTV60 according to the perceived risk, though the
PTV54 or PTV 60 may also extend around the GTV. The associated PTV54 or PTV60
will be comprised of at least 5 mm margins around the entire corresponding CTV.
Plan Scoring
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PTV66 Scoring |
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No Variation |
Minor Variation |
Major Variation |
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95% of PTV66 is at, or above 66.0 Gy and |
90% of PTV66 is at, or above 66.0 Gy and |
Failure to achieve either No Variation or Minor Variation |
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99% of PTV66 is at, or above 61.4 Gy and |
99% of PTV66 is at, or above 60.0 Gy and |
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No more than 20% of PTV66 is at, or above 72.6 Gy |
No more than 25% of PTV66 is at, or above 72.6 Gy |
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PTV60 Scoring |
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No Variation |
Minor Variation |
Major Variation |
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95% of PTV60 is at, or above 60 Gy and |
90% of PTV60 is at, or above 60.0 Gy and |
Failure to achieve either No Variation or Minor Variation |
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99% of PTV60 is at, or above 55.8 Gy and |
99% of PTV66 is at, or above 52.0 Gy and |
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No more than 20% of PTV60* is at, or above 66.0 Gy |
No more than 20% of PTV60 is at, or above 72.6 Gy |
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*PTV60 is evaluated by eliminating all common volume with PTV66.
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PTV54 Scoring |
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No Variation |
Minor Variation |
Major Variation |
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95% of PTV54 is at, or above 54.0 Gy and |
90% of PTV54 is at, or above 54 Gy and |
Failure to achieve either No Variation or Minor Variation |
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99% of PTV54 is at, or above 50.2 Gy and |
99% of PTV54 is at, or above 47.0 Gy and |
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No more than 20% of PTV54* is at, or above 59.4 Gy |
No more than 20% of PTV54* is at, or above 72.6 Gy |
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*PTV54 is evaluated by eliminating all common volume with PTV66.
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Parotid Scoring |
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No Variation |
Minor Variation |
Major Variation |
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Mean dose to either parotid is less than 26.0 Gy or |
60% of either parotid receives less than, or equal to 30.0 Gy |
Failure to achieve either No Variation or Minor Variation |
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50% of either parotid receives less than, or equal to 30.0 Gy or |
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20 cc of the combined parotid glands receive less than 20.0 Gy |
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Organs at Risk (OAR)
Specific tolerance dose values have been established for this protocol. While exceeding these dose values is not prohibited, it is strongly recommended that they not be exceeded.
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Organ at Risk (OAR) |
Dose Limit and Criteria |
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Glottic Larynx |
2/3 below 50.0 Gy |
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Brainstem |
54.0 Gy |
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Spinal Cord+ |
45.0 Gy |
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Mandible |
70.0 Gy |
+The spinal cord should be contoured as 0.5 cm larger in radius than the actual cord. This may be accomplished using a 0.5 cm margin for the Planning Organ at Risk (PRV) if your system supports such.
Document updated 10/30/2003, WLS