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Practice Guideline
. 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

Vincent Grégoire  1 , Mererid Evans  2 , Quynh-Thu Le  3 , Jean Bourhis  4 , Volker Budach  5 , Amy Chen  6 , Abraham Eisbruch  7 , Mei Feng  8 , Jordi Giralt  9 , Tejpal Gupta  10 , Marc Hamoir  11 , Juliana K Helito  12 , Chaosu Hu  13 , Keith Hunter  14 , Jorgen Johansen  15 , Johannes Kaanders  16 , Sarbani Ghosh Laskar  10 , Anne Lee  17 , Philippe Maingon  18 , Antti Mäkitie  19 , Francesco Micciche'  20 , Piero Nicolai  21 , Brian O'Sullivan  22 , Adela Poitevin  23 , Sandro Porceddu  24 , Krzysztof Składowski  25 , Silke Tribius  26 , John Waldron  22 , Joseph Wee  27 , Min Yao  28 , Sue S Yom  29 , Frank Zimmermann  30 , Cai Grau  31
Affiliations
Practice Guideline

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

Vincent Grégoire et al. Radiother Oncol. 2018 Jan.

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.

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