Post-operative radiotherapy for oral cavity squamous cell carcinoma: Review of the data guiding the selection and the delineation of post-operative target volumes

Abstract

Background and purpose: To date, no consensus guidelines have been published that systematically guide delineation of primary and nodal Clinical Target Volumes (CTVs) in patients who require post-operative radiotherapy (PORT) for head and neck squamous cell carcinoma (HNSCC). As a result, significant individual, institutional and national variation exists in the way that CTVs are delineated in the post-operative setting, leading to considerable heterogeneity in radiotherapy treatment.

Methods: A multi-disciplinary group of experts was convened by the European Society for Radiotherapy and Oncology (ESTRO), including radiation oncologists from Europe, North America and Asia, as well as surgery, radiology and pathology representatives. Oral cavity squamous cell carcinoma (OCSCC), where surgery followed by PORT is the standard of care, was first selected for focus. The indications for PORT, and the influence of tumour subsite and stage on post-operative treatment volumes, were considered with reference to current evidence, and clinical experience within the group.

Results: We present clear recommendations regarding the indications for PORT in OCSCC, and propose a new classification of lateralised and non-lateralised OCSCC, to help guide the delineation of post-operative nodal CTVs.

Conclusions: The evidence and expert opinion summarised in this manuscript provides the background and context required to underpin new international consensus guidelines for the delineation of primary and nodal CTVs for OCSCC in the post-operative setting.

Keywords: Lateralised; Non-lateralised; Oral cavity squamous cell carcinoma; Post-operative management.