International GuidelineDelineation 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
Section snippets
Acquisition of the planning CT
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The patient should lie in the supine position on the flat table-top of the simulation CT scanner with his head and neck immobilized in a neutral neck position by a reproducible immobilization device, e.g. 4–5 fixation point thermoplastic mask.
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Thin CT sections should be acquired typically from above the base of skull, cranially, to below the sterno-clavicular joint, caudally; for accurate dose calculation, the upper and lower bound should ideally include at least 5 cm of tissue slab beyond the
Glottic carcinoma
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T1 glottic tumour (Fig. 2): CTV-P1 = GTV-P with a concentrically isotropic margin of 5 mm in all directions. In the axial plane, CTV-P1 does include the paraglottic space, the anterior commissure for anterior vocal cord tumour, the anterior part of the contralateral vocal cord for tumour extending to the anterior commissure, and the vocal process of the arytenoid cartilage for tumour extending to the posterior vocal cord, but excludes the thyroid cartilage and the air cavity; in the
Guidelines for the delineation of the primary tumour CTV for hypopharyngeal SCC
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T1 tumour (Fig. 10): CTV-P1 = GTV-P with a concentrically isotropic margin of 5 mm in all directions. CTV-P1 should always be delineated within CTV-P2.
CTV-P2 = GTV-P with a concentrically isotropic margin of 10 mm in all directions. Depending on the location of the GTV-P, CTV-P2 includes the posterior aspect of the para-laryngeal space (i.e. tumour of the anterior angle and the medial wall of the piriform sinus), the inter-arytenoid area and the arytenoid cartilage (i.e. post-cricoid tumour),
Guidelines for the delineation of the primary tumour CTV for oropharyngeal SCC
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T1 tumour (Fig. 14, Fig. 15): CTV-P1 = GTV-P with a concentrically isotropic margin of 5 mm in all directions. CTV-P1 should always be delineated within CTV-P2.
CTV-P2 = GTV-P with a concentrically isotropic margin of 10 mm in all directions. The CTV-P2 does however not include any air cavity, bony structures (e.g. hyoid bone, mandible, hard palate), or the mobile tongue.
For tonsillar primaries, the CTV-P2 includes the superior pharyngeal constrictor muscle within the 5 mm expansion, but does
Guidelines for the delineation of the primary tumour CTV for oral cavity SCC
It is recognized that squamous cell carcinoma of the oral cavity are mainly treated by surgery followed by radiotherapy or concomitant chemo-radiotherapy. However, for the sake of completion, the following guidelines are proposed for patients who will receive primary radiotherapy because of contraindications to surgery (e.g. poor general conditions of the patient, and/or anticipated very poor functional outcome) and/or refusal of surgery.
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T1 tumour: CTV-P1 = GTV-P with a concentrically isotropic
Discussion
When considering implementing these guidelines, several issues potentially impacting on their clinical use need to be addressed. These are briefly discussed below.
Funding source
None to report.
Ethical considerations
None to declare.
Conflict of interest
All authors declare no conflict of interest.
Acknowledgments
The authors wish to thank A. Bacigalupo, E. Brun, R. Corvò, E. Dale, F. Freire de Arruda, S. Friesland, J. Kazmierska, H. Minn, K. Saarilahti, M.A. Villavicencio Queijeiro, E. Weltman for careful reading of the manuscript and for providing constructive comments.
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