Editor-in-Chief Emeritus Pick of Papers
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For each issue of Radiotherapy and Oncology, the Editor-in-Chief Emeritus Jens Overgaard, picks his favourite papers.
- Intensity Modulated Radiation Therapy (IMRT), Volumetric Modulated Arctherapy (VMAT) or other highly conformal techniques (e.g. proton therapy) are techniques that allow precise targeting of the volumes to be irradiated while protecting healthy tissue. In 2018, it is the standard method of irradiation of head and neck cancers [1–5]. Because of their precision, these techniques require that each target volume be strictly and rigorously defined. The delineation and selection of these volumes is complex and requires a solid learning curve.
- Perineural invasion (PNI) is a well-recognized characteristics in head and neck cancers. It has been associated with poor prognosis, i.e. increased loco-regional recurrence and decreased survival [1–6]. PNI can present from either cutaneous, mucosal, or salivary gland head and neck malignancies . Adenoid cystic carcinoma (ACC) and squamous-cell carcinomas (SCC) are the most frequent neoplasms to exhibit this behavior. PNI is a clinicopathological entity generally defined as tumor-cell invasion in, around, and through the nerves [8,9].
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 guidelinesFew 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.
- Target delineation in nasopharyngeal carcinoma (NPC) often proves challenging because of the notoriously narrow therapeutic margin. High doses are needed to achieve optimal levels of tumour control, and dosimetric inadequacy remains one of the most important independent factors affecting treatment outcome.