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Clin Oncol (R Coll Radiol). 2017 Jan;29(1):42-50. doi: 10.1016/j.clon.2016.09.017. Epub 2016 Nov 1.

Standardisation of Target Volume Delineation for Carotid-sparing Intensity-modulated Radiotherapy in Early Glottis Cancer.

Author information

1
Head and Neck Unit, The Royal Marsden Hospital, London, UK.
2
Department of Physics, Royal Marsden Hospital, London, UK.
3
Speech and Language Therapy Department, Royal Marsden Hospital, London, UK.
4
Head and Neck Unit, The Royal Marsden Hospital, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
5
Head and Neck Unit, The Royal Marsden Hospital, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK. Electronic address: chris.nutting@rmh.nhs.uk.

Abstract

AIMS:

Recently, carotid-sparing intensity-modulated radiotherapy (IMRT) for early laryngeal glottis (T1/T2N0M0) cancer has generated interest in the hope of avoiding long-term carotid toxicity, as well as concerns relating to geographical misses and long-term normal tissue toxicity. The aim of this review was to summarise the current literature on carotid-sparing IMRT for early glottis cancer, with particular focus on definitions of target volumes and the carotid arteries as organs at risk. In addition, we make suggestions for standardisation of these structures, dose constraints and dose reporting.

MATERIALS AND METHODS:

From 73 references, 16 articles met the criteria for inclusion in this systematic review. These papers described two case reports, 11 planning studies and three prospective studies.

RESULTS:

There was variation in all target volume definitions with no clear consensus. The greatest variability was in clinical target volume definition. Carotid artery and spinal cord delineation were not always defined and most studies did not use a carotid artery constraint. Of the eight studies that reported carotid artery delineation, no two studies delineated the same length of carotid artery, yet most studies reported mean doses. Most studies used IMRT with three to seven fields. Five studies used arc therapy and two studies used tomotherapy.

CONCLUSION:

This review highlights a lack of consensus in target volume definitions in carotid-sparing IMRT. Ultimately, long-term prospective data are required to show the benefit of carotid-sparing IMRT. Pooled data will prove useful as most studies will report on small numbers of patients. Therefore, adopting a consensus now on target volume definition, dose constraints and dose reporting will be crucial.

KEYWORDS:

Carotid sparing; glottic cancer; radiotherapy

PMID:
27815039
PMCID:
PMC6155494
DOI:
10.1016/j.clon.2016.09.017
[Indexed for MEDLINE]
Free PMC Article

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