Table A1 Published SBRT Dose Tolerance Limits for Small Bowel, by Fractionation

cc or % / Max / Mean
Num / Vol. / Vol. / Limit / Limit / Limit
Fx / cc / % / Gy / Gy / Gy / Endpoint (≥ G3) / Refs. / Notes
1 / 5% / 22.5 / G3-4 Ulcer/perf. / 1
1 / 50% / 14.5 / G3-4 Ulcer/perf. / 1
1 / 5% / 12.3 / 2 / Mean D5% among first 7 pts at 25Gy in 1fx
1 / 30 / 12.5 / 3,4 / QUANTEC, with avoidance of circumferential coverage above that dose
1 / 21 / G3-4 Ulcer/perf. / 1
1 / 19 / Enteritis/obstruction / 5 / Limit is for Ileum/Jejunum
1 / 5 / 9.8 / Enteritis/obstruction / 5 / Limit is for Ileum/Jejunum
1 / 21.6 / G3 but no Ulceration / 6 / Highest sm intestine/stomach Dmax among 67 cases
1 / 15.1 / G3 but no Ulceration / 6 / Median sm intestine/stomach Dmax over 67 cases
1 / 5 / 11.9 / G3 Enteritis/obstr. / 7,8,9,10 / RTOG 0631, TG101, Limit is for Ileum/Jejunum
1 / 0.03 / 15.4 / G3 Enteritis/obstr. / 7,8,9,10 / RTOG 0631, TG101, Limit is for Ileum/Jejunum
1 / 17.9 / 11 / Pts with VEGFI therapy, BED=125Gy3
1 / 12 / Ulceration / 12,13
1 / 8 / 14
2 / 24.5 / 11 / Pts with VEGFI therapy, BED=125Gy3
3 / 1% / 21 / Ulceration / 15
3 / 29.3 / 11 / Pts with VEGFI therapy, BED=125Gy3
3 / 37 / Ulceration / 16
3 / 5 / 30 / Ulceration / 16
3 / 15 / 24 / Ulceration / 16
3 / 30 / 15 / Ulceration / 16
3 / 10 / 16.2 / Enteritis/obstruction / 17 / Limit is for Ileum/Jejunum
3 / 30 / Ulceration / 4,18,19,20,21,22 / QUANTEC
3 / 27 / Ulceration / 5,17,23 / Limit is for Ileum/Jejunum

Table A1 (cont’d) Published SBRT Dose Tolerance Limits for Small Bowel, by Fractionation

cc or % / Max / Mean
Num / Vol. / Vol. / Limit / Limit / Limit
Fx / cc / % / Gy / Gy / Gy / Endpoint (≥ G3) / Refs. / Notes
3 / 25.2 / Enteritis/obstruction / 8 / TG101, Limit is for Ileum/Jejunum
3 / 24 / Ulceration / 13,24
3 / 5 / 21 / 25,26,27,28,29,30,31
3 / 5 / 17.7 / Enteritis/obstruction / 8 / TG101, Limit is for Ileum/Jejunum
3 / 5 / 16.2 / Enteritis/obstruction / 5 / Limit is for Ileum/Jejunum
3 / 5 / 16 / Ulceration / 23
3 / 1 / 21 / 31,32,33
3 / 21 / 34
3 / 2 / 15 / Ulceration / 35 / 19.5Gy/3fx boost followed by 50.4Gy/28fx
3 / 1 / 15 / Ulceration / 35 / 19.5Gy/3fx boost followed by 50.4Gy/28fx
3 / 10 / Ulceration / 36 / RTOG 9708, after 45Gy conventional
4 / 33.2 / 11 / Pts with VEGFI therapy, BED=125Gy3
4 / 34.2 / 37 / Minor Deviation
4 / 28.5 / 37
4 / 27 / Ulceration / 38
4 / 5 / 23 / Ulceration / 38
4 / 30 / 4 / QUANTEC
5 / 30 / 4 / QUANTEC
5 / 42 / Ulceration / 16 / 1 G5 duodenal perforation, local tumor invasion
5 / 5 / 38 / Ulceration / 16 / 1 G5 duodenal perforation, local tumor invasion
5 / 15 / 32.5 / Ulceration / 16 / 1 G5 duodenal perforation, local tumor invasion
5 / 30 / 20 / Ulceration / 16 / 1 G5 duodenal perforation, local tumor invasion
5 / 36.4 / 11 / Pts with VEGFI therapy, BED=125Gy3
5 / 40 / Ulceration / 39

Table A1 (cont’d) Published SBRT Dose Tolerance Limits for Small Bowel, by Fractionation

cc or % / Max / Mean
Num / Vol. / Vol. / Limit / Limit / Limit
Fx / cc / % / Gy / Gy / Gy / Endpoint (≥ G3) / Refs. / Notes
5 / 10 / 19.5 / Enteritis/obstruction / 17 / Limit is for Ileum/Jejunum
5 / 5 / 19.5 / Enteritis/obstruction / 5,8,40 / TG101, Limit is for Ileum/Jejunum
5 / 35 / Ulceration / 5,8,40,41 / TG101, Limit is for Ileum/Jejunum
5 / 29 / Ulceration / 17,38 / Limit is for Ileum/Jejunum
5 / 5 / 25 / Ulceration / 38
5 / 45 / Ulceration / 42
5 / 1 / 35 / Ulceration / 41,42
5 / 5 / 30 / Ulceration / 41,42
5 / 7 / 25 / 42
5 / 14 / 20 / 42
5 / 1.6 / 30 / Ulceration / 41 / Median V30Gy over 73 cases
5 / 20 / Ulceration / 41
5 / 1 / 30 / 43
5 / 1 / 25 / 44

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