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Radiother Oncol. 2018 Jan;126(1):3-24. doi: 10.1016/j.radonc.2017.10.016. Epub 2017 Nov 24.

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.

Author information

1
Université catholique de Louvain, St-Luc University Hospital, Department of Radiation Oncology, Brussels, Belgium. Electronic address: Vincent.gregoire@uclouvain.be.
2
Velindre Cancer Centre, Department of Radiation Oncology, Wales, UK.
3
Stanford University School of Medicine, Department of Radiation Oncology, USA.
4
CHUV and University of Lausanne, Department of Radiation Oncology, Switzerland.
5
Charité University Hospital, Department of Radio-oncology and Radiotherapy, Berlin, Germany.
6
Sun Yat-Sen University, Cancer Centre, Department of Radiation Oncology, Guangzhou, China.
7
University of Michigan Health System, Department of Radiation Oncology, Ann Arbor, USA.
8
Department of Radiation Oncology, Sichuan Cancer Hospital, Chengdu, China.
9
Vall d'Hebron University Hospital, Radiation Oncology Service, Barcelona, Spain.
10
Tata Memorial Hospital, Department of Radiation Oncology, Mumbai, India.
11
Université catholique de Louvain, St-Luc University Hospital, Department of Head and Neck Surgery, Brussels, Belgium.
12
Hospital Israelita Albert Einstein, Department of Radiation Oncology, Sao Paulo, Brazil.
13
Fudan University Shanghai Cancer Center, Department of Radiation Oncology, China.
14
University of Sheffield, School of Clinical Dentistry, Unit of Oral and Maxillofacial Pathology, UK.
15
Odense University Hospital, Department of Oncology, Denmark.
16
Radboud University Medical Centre, Department of Radiation Oncology, Nijmegen, The Netherlands.
17
University of Hong Kong and University of Hong Kong Shenzhen Hospital, Department of Clinical Oncology, Hong Kong, China.
18
Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Department of Radiation Oncology, Paris, France.
19
University of Helsinki and Helsinki University Hospital, Department of Otorhinolaryngology - Head & Neck Surgery, Finland.
20
Universita' Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Polo Scienze Oncologiche ed Ematologiche, Rome, Italy.
21
University of Brescia, Divisions of Otorhinolaryngology - Head and Neck Surgery, Italy.
22
University of Toronto, The Princess Margaret Hospital, Department of Radiation Oncology, Canada.
23
Medica Sur, Unit for Radiotherapy, México DF, Mexico.
24
Princess Alexander Hospital, Department of Radiation Oncology, Brisbane, Australia.
25
Institute of Oncology, Maria Sklodowska-Curie Cancer Center, Gliwice, Poland.
26
Asklepios St. Georg Hospital, Hermann-Holthusen Institute for Radiotherapy, Hamburg, Germany.
27
National Cancer Centre Singapore, Division of Radiation Oncology, Singapore.
28
Case Western Reserve University Hospital, Department of Radiation Oncology, Cleveland, USA.
29
University of California-San Francisco, Department of Radiation Oncology, USA.
30
University Hospital Basel, Clinic of Radiotherapy and Radiation Oncology, Switzerland.
31
Aarhus University Hospital, Department of Oncology, Denmark.

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.

KEYWORDS:

Clinical Target Volume (CTV); Gross Tumour Volume (GTV); Guideline; Head and neck; Radiotherapy

PMID:
29180076
DOI:
10.1016/j.radonc.2017.10.016
[Indexed for MEDLINE]

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