RTOG consensus panel atlas of male and female pelvic normal tissues. Citation as given in the eviQ reference list; not yet checked against the journal.
Femoral Heads
Dose constraints
Cervix — Definitive Chemoradiation
| Schedule | Constraint | Source |
|---|---|---|
| 45–50.4 Gy / 25–28 fx Pelvis ± nodal boost | D15% ≤30 Gy, D0.03 cc ≤50 Gy | NRG cervix RT template |
Quoted from NRG cervix RT template, checked 2026-09-30. Full table with references →
Endometrium & Cervix — Post-operative
| Schedule | Constraint | Source |
|---|---|---|
| 45–50.4 Gy / 25–28 fx Post-operative pelvis | D15% ≤30 Gy, D0.03 cc ≤50 Gy | NRG endometrial RT template |
Quoted from NRG endometrial RT template, checked 2026-09-30. Full table with references →
Vulva
| Schedule | Constraint | Source |
|---|---|---|
| 45–50.4 Gy / 25–28 fx + boost Composite plan (SIB or sequential boost) | D15% ≤30 Gy, D5% ≤40 Gy | NRG vulva RT template |
| D0.03 cc ≤50 Gy | NRG vulva RT template |
Treating the inguinofemoral nodes brings dose close to the femoral heads and necks.
Quoted from NRG vulva RT template, checked 2026-09-30. Full table with references →
Anatomy
The rounded upper ends of the femurs that sit in the acetabulum of the pelvis. Planning structures often include the femoral neck as well, down to about the level of the lesser trochanter.
Function in the body
The femoral head is the ball of the hip joint, carrying the body's weight from the pelvis to the leg.
Why it matters
The concern is femoral head necrosis or femoral neck fracture — rare with modern planning but serious. Lateral beams in older 3D techniques could deliver meaningful dose here; with IMRT and VMAT the limits are usually met easily, but they still need checking, especially when lateral arcs or beam angles concentrate dose through the hips.
In rectal and anal cancer the elective nodal volumes (internal and external iliac, and inguinal in anal cancer) sit close to the femoral heads and necks, so their limits are checked in every pelvic GI plan.
In gynecologic treatment the external iliac and (for vulvar cancer) inguinofemoral nodal volumes pass close to the femoral heads and necks. NRG's GYN templates write their limits as D15% plus a near-maximum (D0.03 cc).
How to contour
Sources draw quite different structures:
- Gay 2012 (proximal femur): from the top of the ball of the femur down to the lowest level of the ischial tuberosities, including the trochanters. A bone threshold auto-contour helps, but edit it afterwards.
- The NRG anal cancer template (femoral head): the femoral head excluding the femoral neck, with the bottom border at the lesser trochanter.
- Timmerman 2022 (Tables 8–11, written for its SBRT dose tables): contour the right and left separately.
Because the volumes differ, a limit only makes sense on the structure it was written for.
The template NRG Oncology gives investigators for writing the radiation therapy section of an anal cancer trial. Its example text and values are based on RTOG 0529 and the ECOG-ACRIN DECREASE trial (EA2182), and are meant to be edited for each protocol. It covers immobilization (a supine "frog-leg" position is recommended), CT or PET/CT simulation, rigid registration of MRI and PET to the planning CT, standard structure names, dose compliance tables and planning priorities.
An editorial history of the UT Southwestern SABR constraint tables — often called the “Timmerman tables” — covering how they were developed and revised, and their relationship to AAPM TG-101 and NRG/RTOG protocols. Tables 2–11 separate serial tissues (listed with a volume, a volume max and a max point dose) from parallel tissues (listed with a critical volume and a critical-volume dose max). In Tables 2–7 a footnote defines “point” as ≤0.035 cm³; Tables 8–11 add a contouring-instructions column for each structure.
Further reading
- QUANTEC — QUANTEC — Quantitative Analyses of Normal Tissue Effects in the Clinic Source
- ENZARAD protocol — ENZARAD (ANZUP 1303): a randomised phase 3 trial of enzalutamide in androgen deprivation therapy with radiation therapy for high risk, clinically localised, prostate cancer Source
- King 2012 — Long-term outcomes from a prospective trial of stereotactic body radiotherapy for low-risk prostate cancer Source
- NRG cervix RT template — NRG Oncology Protocol Development Template for Radiation Therapy — Gynecological Cancer: Cervix, Uterine Cervix Source
- NRG vulva RT template — NRG Oncology Protocol Development Template for Radiation Therapy — Gynecological Cancer: Vulva Cancer Source