☆ 4.7 Article Proceedings Paper

International guideline for the delineation of the clinical target volumes (CTV) for nasopharyngeal carcinoma

RADIOTHERAPY AND ONCOLOGY (2018)

Journal

RADIOTHERAPY AND ONCOLOGY

Volume 126, Issue 1, Pages 25-36

Publisher

ELSEVIER IRELAND LTD

DOI: 10.1016/j.radonc.2017.10.032

Keywords

Nasopharyngeal carcinoma; Clinical target volume (CTV); Gross target volume (GTV); Guideline; Delineation

Funding

MRC [MR/M009068/1] Funding Source: UKRI
Cancer Research UK [13407] Funding Source: Medline
Medical Research Council [MR/M009068/1] Funding Source: Medline
Cancer Research UK [23275] Funding Source: researchfish
National Institute for Health Research [NF-SI-0515-10101] Funding Source: researchfish

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Abstract

Purpose: Target delineation in nasopharyngeal carcinoma (NPC) often proves challenging because of the notoriously narrow therapeutic margin. High doses are needed to achieve optimal levels of tumour control, and dosimetric inadequacy remains one of the most important independent factors affecting treatment outcome. Method: A review of the available literature addressing the natural behaviour of NPC and correlation between clinical and pathological aspects of the disease was conducted. Existing international guidelines as well as published protocols specified by clinical trials on contouring of clinical target volumes (CTV) were compared. This information was then summarized into a preliminary draft guideline which was then circulated to international experts in the field for exchange of opinions and subsequent voting on areas with the greatest controversies. Results: Common areas of uncertainty and variation in practices among experts experienced in radiation therapy for NPC were elucidated. Iterative revisions were made based on extensive discussion and final voting on controversial areas by the expert panel, to formulate the recommendations on contouring of CTV based on optimal geometric expansion and anatomical editing for those structures with substantial risk of microscopic infiltration. Conclusion: Through this comprehensive review of available evidence and best practices at major institutions, as well as interactive exchange of vast experience by international experts, this set of consensus guidelines has been developed to provide a practical reference for appropriate contouring to ensure optimal target coverage. However, the final decision on the treatment volumes should be based on full consideration of individual patients' factors and facilities of an individual centre (including the quality of imaging methods and the precision of treatment delivery). (C) 2017 Elsevier B.V. All rights reserved.

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Characteristics of local extension based on tumor distribution in nasopharyngeal carcinoma and proposed clinical target volume delineation

Zheng Wu, Bin Qi, Fei-Fei Lin, Lin Zhang, Qian He, Fei-Ping Li, Hui Wang, Ya-Qian Han, Wen-Jing Yin

Summary: MRI can be used to evaluate the local extension of nasopharyngeal carcinoma and improve clinical target volume delineation. Nasopharyngeal carcinoma can be divided into eccentric and central lesions, with distinct invasion features. Individualized target delineation should be based on the distribution characteristics of tumors, and routine prophylactic radiation may not be necessary for contralateral parapharyngeal space and skull base foramina in eccentric lesions.

RADIOTHERAPY AND ONCOLOGY (2023)