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

Publication date: Available online 24 November 2017
Source:Radiotherapy and Oncology
Author(s): Vincent Grégoire, Mererid Evans, Quynh-Thu Le, Jean Bourhis, Volker Budach, Amy Chen, Abraham Eisbruch, Mei Feng, Jordi Giralt, Tejpal Gupta, Marc Hamoir, Juliana K. Helito, Chaosu Hu, Keith Hunter, Jorgen Johansen, Johannes Kaanders, Sarbani Ghosh Laskar, Anne Lee, Philippe Maingon, Antti Mäkitie, Francesco Micciche', Piero Nicolai, Brian O'Sullivan, Adela Poitevin, Sandro Porceddu, Krzysztof Składowski, Silke Tribius, John Waldron, Joseph Wee, Min Yao, Sue S. Yom, Frank Zimmermann, Cai Grau
PurposeFew 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.MethodFor 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.ResultsThis 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.ConclusionImplementation 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.



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