What volumetric dose constraints, if any, do you use for the mandible in the definitive setting for H&N cancers?

The planning directions for the mandible are typically <50 Gy. However, when the targets are adjacent to the mandible we do not constrain the maximal mandibular dose if it may compromise target dose. In that case, we plan a dose gradient across the mandible, with the mucosa and inner plate of the bo...

Agree, tumor coverage in definitive setting is first priority.

We use mandible constraints below:

• Mandible D0.03cc
  • No tumor overlap with PTV: <70 Gy
  • Tumor overlap with PTV: <73.5 Gy

• Multiple studies recommend minimizing mandible volume >50 Gy to >60 Gy, but I am not aware of specific thresho...

We use four constraints for the mandible, all prioritized secondary to target coverage:

• D0.03cc < 73.5Gy
• V70Gy < 5cc
• V58Gy < 25%
• V44Gy < 42%

We have not incorporated the D30% values from the NTCP model (at least not yet). But I think the dose-response relationship depicted by this model is informati...