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

Abstract

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.

Locoregional failures and their relation to radiation fields following stereotactic body radiotherapy boost for oropharyngeal squamous cell carcinoma

“…Rigorous quality assurance of both target delineation and delivery remain critical particularly with advanced technology such as stereotactic RT. CTV construction by 1 cm volumetric expansion of the GTV was likely sufficient in the vast majority of cases and is consistent with recently published international consensus guidelines; pathology studies have found nearly all microscopic tumor infiltration within 10 mm of the tumor . Similarly, target delineation was consistent with recommended guidelines (contrast‐enhanced planning CT fused with a diagnostic MRI) and image‐guidance was state‐of‐the‐art (cone beam CT, and for the SBRT boost, spinal tracking using orthogonal X‐rays), such that these were not likely factors in the high out‐of‐field recurrence rates.…”

“…CTV construction by 1 cm volumetric expansion of the GTV was likely sufficient in the vast majority of cases and is consistent with recently published international consensus guidelines; pathology studies have found nearly all microscopic tumor infiltration within 10 mm of the tumor . Similarly, target delineation was consistent with recommended guidelines (contrast‐enhanced planning CT fused with a diagnostic MRI) and image‐guidance was state‐of‐the‐art (cone beam CT, and for the SBRT boost, spinal tracking using orthogonal X‐rays), such that these were not likely factors in the high out‐of‐field recurrence rates. Although reduction of the CTV for the SBRT boost based on tumor response following the IMRT phase may theoretically increase out‐of‐field failures, this is not likely a contributing factor to the out‐of‐field failures in the present study.…”

Failure patterns of head and neck squamous cell carcinoma treated with radical radiotherapy by intensity modulated radiotherapy technique using focal volume and dosimetric method

“…Increasing diagnostic capabilities and accordingly updating “intermediate dose” target delineation may help to reduce such failures. One such attempt has been recently made in the formulation of consensus guidelines to delineate various TVs …”

The GIRAFE phase II trial on MVCT-based “volumes of the day” and “dose of the day” addresses when and how to implement adaptive radiotherapy for locally advanced head and neck cancer

“…Target volumes will be delineated based on international recommendations [22], [23] after manual rigid registration with the PET planning CT and an MRI if available.…”