Many studies have been done to test normal tissue tolerances.

These studies are

of increasing importance due to the growing number of cancer survivors (a tripling in the
United States between 1970 and 2001), and provide researchers with important
knowledge regarding late effects of radiation to normal structures.1
Two popular studies that are frequently referenced are the Emami study,
published in 1991, and the QUANTEC study. The earlier Emami publication provides
tolerance doses for the irradiation of one third, two thirds, or the whole of various critical
structures within the body. A drawback to this data is that at the time of the study,
clinical data was limited, so the task force established these parameters by a consensus of
clinical experience and opinions; additionally, the data is based on the organ being
uniformly irradiated.1
The QUANTEC study, published 19 years after the Emami study, provides
evidence based guidelines and allows the clinician to reasonably categorize toxicity risk
based on dose/volume parameters.2 One drawback to this study, according to Emami,2 is
that it fails in providing a simple visual for “safe” doses, such as a summary table
showing a specific dose that each organ shouldn’t go beyond. However, the QUANTEC
summary table provides information that may be very useful in today’s clinical
environment. For example, it shows what the percentage risk is for certain side effects
for a given dose range, which can be very useful when having to decide what constitutes
an acceptable dose to a critical structures while also maximizing coverage to the tumor
volume.
With the different advancements in radiation oncology, such as IMRT, clinicians
are able to treat different field sizes and manipulate doses in ways that were not possible
in the past. Because of this, it is increasingly important to consider the doses being given
to surrounding normal structures in addition to the long-term effects these doses may
have.

1. Bentzen SM, Constine LS, Deasy JO, et al. Quantitative analyses of normal tissue
effects in the clinic (QUANTEC): an introduction to the scientific issues.
International Journal of Radiation Oncology, Biology, Physics. 2010;76(3)S6-S9.
doi: http://dx.doi.org/10.1016/j.ijrobp.2009.09.040.
2. Mulcahy N. A long time coming: new guidance on “normal tissue effects” for
radiation oncology. Medscape Web site.
https://www.medscape.com/viewarticle/720293. Accessed January 30, 2018.