Radiation therapy is an integral tool used in the treatment of the majority of curative and

palliative cancer cases. Therapeutic radiotherapy unfortunately affects both normal and diseased cells,
and it is our goal to increase the efficacy of our treatments while limiting dose given to healthy tissues.
In order to do so, documents such as the Emami paper and the QUANTEC review have been published,
describing optimal dose and volume limitations.
In 1991, clinicians and researchers developed the Emami paper, a piece regarded as a consensus
for partial organ tolerance doses.1 At the time, CT simulation was rare, 3D conformal radiation therapy
was in its early stages, and dose volume histograms (DVHs) were just being implemented as a new tool.
Because of these limitations, the data presented was mostly based on clinical experience and opinions
of professionals within the field. The researchers formed a document that provided organ dose
tolerances for the irradiation of 1/3, 2/3, and the entirety of various critical organ structures.
The years following the Emami paper provided an increase in computer capability, the
development of new fractionation and treatment methods, and the publishing of the 2010 consensus
update to Emami paper, known as QUANTEC. (Quantitative analysis of normal tissue effects in clinic).
This review was designed to assess the advances in dose/volume/outcome modeling following the
Emami paper in 1991 and was a necessity based off of the dramatic changes the field had seen. Newer
technology presented radiation oncology teams with an increase in methods and flexibility in the
manner in which they could treat a target area. This flexibility also increased the possibilities and
combinations of the regions of normal tissue that could be included and irradiated incidentally in a plan.
The QUANTEC data gave data optimizing the understanding of 3D dose distributions and the optimal
dose in which to achieve a therapeutic ratio.2 An example of a method researched by the QUANTEC
group is the use of SRS (Stereotactic Radiosurgery).3 The group reviewed literature and established dose
limits for several CNS organs when using SRS. Ultimately, the field continues to grow and with that, the
research and understanding must keep pace in order to provide optimal therapeutic care.

1. Marks LB, Yorke ED, Jackson A, et al. International journal of radiation oncology, biology, physics.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4041542/. Published March 1, 2010. Accessed
February 7, 2018.
2. Bentzen SCBM, et. al. Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): An
Introduction to the Scientific Issues. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431964/.
Published March 1, 2010. Accessed February 2018.
3. Emami B. Advanced Search. Reports of Radiotherapy and Oncology.
http://radioncology.com/en/advanced/result.html. Published 2013. Accessed February 7, 2018.