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Practical clinical guidelines for contouring the trigeminal nerve (V) and its branches in head and neck cancers

Published:September 08, 2018DOI:https://doi.org/10.1016/j.radonc.2018.08.020

      Highlights

      • The trigeminal nerve (V) is a major route of tumor spread in head and neck cancers.
      • Recognizing the radio-anatomy and potential routes of invasion is essential.
      • We provide here delineation and treatment guidelines for the trigeminal nerve and its branches.
      • A CT- and MRI-based atlas is also proposed to illustrate the whole trigeminal nerve pathway.

      Abstract

      Purpose

      The trigeminal nerve (V) is a major route of tumor spread in several head and neck cancers. However, only limited data are currently available for its precise contouring, although this is absolutely necessary in the era of intensity-modulated radiation therapy (IMRT). The purpose of this article is to present practical clinical guidelines for contouring the trigeminal nerve (V) in head and neck cancers at risk of spread along this nerve.

      Method

      The main types of head and neck cancers associated with risks of spread along the trigeminal nerve (V) and its branches were comprehensively reviewed based on clinical experience, literature-based patterns of failure, anatomy and radio-anatomy. A consensus for contouring was proposed based on a multidisciplinary approach among head and neck oncology experts including radiation oncologists (JBi, ML, MO, VG and JB), a radiologist (VD) and a surgeon (CS). These practical clinical guidelines have been endorsed by the GORTEC (Head and Neck Radiation Oncology Group).

      Results

      We provided contouring and treatment guidelines, supported by detailed figures and tables to help, for the trigeminal nerve and its branches: the ophthalmic nerve (V1), the maxillary nerve (V2) and the manidibular nerve (V3). A CT- and MRI-based atlas was proposed to illustrate the whole trigeminal nerve pathway with its main branches.

      Conclusion

      Trigeminal nerve (V) invasion is an important component of the natural history of various head and neck cancers. Recognizing the radio-anatomy and potential routes of invasion is essential for optimal contouring, as presented in these guidelines.

      Keywords

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