描述口腔鳞状细胞癌术后原发肿瘤和结临床靶体积:欧洲放射与肿瘤学会(ESTRO)临床指南。

IF 5.3 1区 医学 Q1 ONCOLOGY
Mererid Evans , Pierluigi Bonomo , Po Chung Chan , Melvin L.K. Chua , Jesper Grau Eriksen , Keith Hunter , Kenneth Jensen , T.M. Jones , Sarbani Ghosh Laskar , Roberto Maroldi , Brian O’Sullivan , Claire Paterson , Luca Tagliaferri , Silke Tribius , Sue S. Yom , Vincent Gregoire
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引用次数: 0

摘要

背景和目的:迄今为止,尚未发表一致的指南,系统地指导需要术后放疗(PORT)的粘膜头颈部鳞状细胞癌(HNSCC)患者的原发性和结性临床靶体积(CTVs)的描绘。因此,在术后环境中ctv的描述方式存在显著的个体、机构和国家差异,导致放疗治疗的相当大的异质性。方法:由欧洲放射与肿瘤学会(ESTRO)召集的多学科专家组制定了口腔鳞状细胞癌(OCSCC)的多学科管理原则。在此基础上,并采用先前原发性CTV划定指南中描述的几何扩展方法,专家组提出了新的共识指南,用于原发性肿瘤和淋巴结区域的术后CTV划定,然后与第二级国际专家共享,以确保其在全球范围内的可接受性和适用性。结果:这些指南建议在放疗计划扫描上重新创建代表切除的原发性和结性总肿瘤体积(分别为GTV-P和GTV-N)的替代体积,通过与诊断成像注册或参考解剖标志。原发肿瘤(CTV- p)的术后CTV被创建为一个复合体积,包括:i)替代GTV-P周围的几何扩张,以及ii)手术缺陷和/或重建皮瓣周围的几何扩张。术后淋巴结区(CTV- n)的CTV被创建为一个复合体积,包括:i)替代GTV-N周围的几何扩张,ii)受累淋巴结水平(CTV- n1)。其中包括了在预防剂量CTV (CTV- n2)中划定危险淋巴结水平的指南,以及决定是否需要单侧和/或双侧颈部治疗的指南。结论:在临床实践中实施这些指南应减少差异,并通过促进方法的一致性,促进包括放射治疗质量保证(RTQA)在内的OCSCC患者的多机构审计和临床试验。预计它们将成为未来指南的基础,旨在标准化其他头颈部亚部位的术后CTV划定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Delineation of the post-operative primary tumour and nodal clinical target volumes in oral cavity squamous cell carcinoma: European Society for Radiotherapy and Oncology (ESTRO) clinical guidelines

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 mucosal 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 convened by the European Society for Radiotherapy and Oncology (ESTRO) set-out principles for the multi-disciplinary management of oral cavity squamous cell carcinoma (OCSCC). Building on these, and adapting the geometric expansion approach described in previous primary CTV delineation guidelines, new consensus guidelines for the delineation of post-operative CTVs, both for the primary tumour and nodal regions, were proposed by the expert group, before being shared with a second tier of international experts to ensure their worldwide acceptability and applicability.

Results

These guidelines propose that surrogate volumes representing the resected primary and nodal Gross Tumour Volumes (GTV-P and GTV-N respectively) are re-created on the radiotherapy planning scan, either by registration with diagnostic imaging or via reference to anatomical landmarks. A post-operative CTV for the primary tumour (CTV-P) is created as a composite volume that includes: i) geometric expansion around the surrogate GTV-P, and ii) geometric expansion around the surgical defect and/or reconstruction flap. A post-operative CTV for the nodal region (CTV-N) is created as a composite volume that includes: i) geometric expansion around the surrogate GTV-N, and ii) the involved nodal level (CTV-N1). Guidelines for delineating at-risk nodal levels in a prophylactic dose CTV (CTV-N2) are included, and for making decisions regarding the need for unilateral and/or bilateral neck treatment.

Conclusions

Implementation of these guidelines into clinical practice should reduce variation, and by promoting consistency of approach, facilitate multi-institutional audits and clinical trials including Radiation Therapy Quality Assurance (RTQA) in patients with OCSCC. It is anticipated that they will form the basis for future guidelines aiming to standardise post-operative CTV delineation in other head and neck subsites.
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来源期刊
Radiotherapy and Oncology
Radiotherapy and Oncology 医学-核医学
CiteScore
10.30
自引率
10.50%
发文量
2445
审稿时长
45 days
期刊介绍: Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.
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