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

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    Anne W Lee, Department of Clinical Oncology, University of Hong Kong and University of Hong Kong Shenzhen Hospital, Hong Kong, China., Wai Tong Ng, Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong., Jian Ji Pan, Department of Radiation Oncology, Fujian l Cancer Hospital, Fujian Medical University, Fuzhou, China., Sharon S Poh, Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore., Yong Chan Ahn, Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea., Hussain AlHussain, Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia., June Corry, Radiation Oncology, GenesisCare, St. Vincent's Hospital, Melbourne, Australia.,
  • Cai Grau
  • Vincent Grégoire, Department of Radiation Oncology, Université catholique de Louvain, St-Luc University Hospital, Brussels, Belgium., Kevin J Harrington, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK., Chao Su Hu, Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China., Dora L Kwong, Department of Clinical Oncology, University of Hong Kong and Queen Mary Hospital, Hong Kong., Johannes A Langendijk, Department of Radiotherapy, University Medical Center Groningen, University of Groningen, The Netherlands., Quynh Thu Le, Department of Radiation Oncology, Stanford University, NRG Oncology and HNCIG, USA., Nancy Y Lee, Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, USA., Jin Ching Lin, Department of Radiation Oncology, Taichung Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan., Tai Xiang Lu, Department of Radiation Oncology, Cancer Center of Sun Yat-Sen University, Guangzhou, China., William M Mendenhall, Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, USA., Brian O'Sullivan, Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Canada., Enis Ozyar, Department of Radiation Oncology, Acibadem University School of Medicine, Istanbul, Turkey., Lester J Peters, Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia., David I Rosenthal, Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, USA., Yoke Lim Soong, Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore., Yungan Tao, Department of Radiation Oncology, Institut Gustave Roussy, Paris-Saclay University, Villejuif, France., Sue S Yom, Department of Radiation Oncology, University of California - San Francisco, USA., Joseph T Wee
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).
TidsskriftRadiotherapy & Oncology
Sider (fra-til)25-36
Antal sider12
StatusUdgivet - 2018

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