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. 2012 Apr;103(1):92-8.
doi: 10.1016/j.radonc.2012.02.010. Epub 2012 Mar 9.

Heterogeneity in head and neck IMRT target design and clinical practice

Theodore S Hong  1 , Wolfgang A Tomé, Paul M Harari
Affiliations

Heterogeneity in head and neck IMRT target design and clinical practice

Theodore S Hong et al. Radiother Oncol. 2012 Apr.

Abstract

Purpose: To assess patterns of H&N IMRT practice with particular emphasis on elective target delineation.

Materials and methods: Twenty institutions with established H&N IMRT expertise were solicited to design clinical target volumes for the identical H&N cancer case. To limit contouring variability, a primary tonsil GTV and ipsilateral level II node were pre-contoured. Participants were asked to accept this GTV, and contour their recommended CTV and PTV. Dose prescriptions, contouring time, and recommendations regarding chemotherapy were solicited.

Results: All 20 institutions responded. Remarkable heterogeneity in H&N IMRT design and practice was identified. Seventeen of 20 centers recommended treatment of bilateral necks whereas 3/20 recommended treatment of the ipsilateral neck only. The average CTV volume was 250 cm(3) (range 37-676 cm(3)). Although there was high concordance in coverage of ipsilateral neck levels II and III, substantial variation was identified for levels I, V, and the contralateral neck. Average CTV expansion was 4.1mm (range 0-15 mm). Eight of 20 centers recommended chemotherapy (cisplatin), whereas 12/20 recommended radiation alone. Responders prescribed on average 69 and 68 Gy to the tumor and metastatic node GTV, respectively. Average H&N target volume contouring time was 102.5 min (range 60-210 min).

Conclusion: This study identifies substantial heterogeneity in H&N IMRT target definition, prescription, neck treatment, and use of chemotherapy among practitioners with established H&N IMRT expertise. These data suggest that continued efforts to standardize and simplify the H&N IMRT process are desirable for the safe and effective global advancement of H&N IMRT practice.

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Conflict of interest statement

Conflict of interest statement

None of the authors has a conflict of interest regarding the work presented in this manuscript.

Figures

Fig. 1
Fig. 1
T2 N1 M0 sample tonsil cancer. Panels A and B depict representative CT images through the tonsil and nodal GTV respectively. Panel C shows lateral radiograph with tonsil GTV (red) and nodal GTV (green).
Fig. 2
Fig. 2
Heterogeneity in H&N target delineation. Nine distinct CTV designs which illustrate broad practitioner-dependent variation in target delineation strategies for the identical tonsil cancer case.
Fig. 3
Fig. 3
Dose prescription. Representative sample dose prescription from two different centers. See institutions 5 and 13 in Table 2 for specific fractionation schedule details.
See this image and copyright information in PMC

References

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