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Delineation of the primary tumour Clinical Target Volumes (CTV-P) in laryngeal, hypopharyngeal, oropharyngeal and oral cavity squamous cell carcinoma: AIRO, CACA, DAHANCA, EORTC, GEORCC, GORTEC, HKNPCSG, HNCIG, IAG-KHT, LPRHHT, NCIC CTG, NCRI, NRG Oncology, PHNS, SBRT, SOMERA, SRO, SSHNO, TROG consensus guidelines

Published:November 24, 2017DOI:https://doi.org/10.1016/j.radonc.2017.10.016

      Abstract

      Purpose

      Few studies have reported large inter-observer variations in target volume selection and delineation in patients treated with radiotherapy for head and neck squamous cell carcinoma. Consensus guidelines have been published for the neck nodes (see Grégoire et al., 2003, 2014), but such recommendations are lacking for primary tumour delineation. For the latter, two main schools of thoughts are prevailing, one based on geometric expansion of the Gross Tumour Volume (GTV) as promoted by DAHANCA, and the other one based on anatomical expansion of the GTV using compartmentalization of head and neck anatomy.

      Method

      For each anatomic location within the larynx, hypopharynx, oropharynx and oral cavity, and for each T-stage, the DAHANCA proposal has been comprehensively reviewed and edited to include anatomic knowledge into the geometric Clinical Target Volume (CTV) delineation concept. A first proposal was put forward by the leading authors of this publication (VG and CG) and discussed with opinion leaders in head and neck radiation oncology from Europe, Asia, Australia/New Zealand, North America and South America to reach a worldwide consensus.

      Results

      This consensus proposes two CTVs for the primary tumour, the so called CTV-P1 and CVT-P2, corresponding to a high and lower tumour burden, and which should be associated with a high and a lower dose prescription, respectively.

      Conclusion

      Implementation of these guidelines in the daily practice of radiation oncology should contribute to reduce treatment variations from clinicians to clinicians, facilitate the conduct of multi-institutional clinical trials, and contribute to improved care of patients with head and neck carcinoma.

      Abbreviations:

      AIRO (Italian Association of Radiation Oncologists), CACA (committee of head & neck cancer, the committee of nasopharyngeal cancer, China Anti-Cancer Association), DAHANCA (Danish Head and Neck Cancer Group), EORTC (European Organisation for Research and Treatment of Cancer), GEORCC (Grupo Español de Oncologia Radioterapia para Cancer Cabeza y Cuello), GORTEC (Groupe d’Oncologie Radiothérapie Tête Et Cou), HKNPCSG (Hong Kong Naso Pharynx Cancer Study Group), HNCIG (Head & Neck Cancer Inter Group), IAG-KHT (Interdisziplinäre Arbeitsgruppe für Kopf-Hals-Tumore), LPRHHT (Dutch National Platform Radiotherapy Head and Neck Cancer), NCIC-CTG (National Cancer Institute of Canada Clinical Trials Group), NCRI (National Cancer Research Institute), NRG-Oncology (NSABP (National Surgical Adjuvant Breast and Bowel Project) – RTOG (Radiation Therapy Oncology Group) – GOG (Gynecologic Oncology Group) Oncology), PHNS (Polish Head & Neck Society), SBRT (Sociedade Brasileira de Radioterapia), SOMERA (Sociedad Mexicana de Radioterapeutas), SRO (Swiss Society for Radiation Oncology), SSHNO (Scandinavian Society for H&N Oncology), TROG (Trans-Tasman Radiation Oncology Group)

      Keywords

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