Target volume selection and delineation (T and N) for primary radiation treatment of oral cavity, oropharyngeal, hypopharyngeal and laryngeal squamous cell carcinoma

Oral Oncol. 2018 Dec;87:131-137. doi: 10.1016/j.oraloncology.2018.10.034. Epub 2018 Nov 3.

Abstract

Target volume selection and delineation for both the primary tumor and the lymph nodes are critical steps in the treatment of head and neck tumors with Intensity Modulated Radiation therapy (IMRT). These steps should be based on a probabilistic approach, which is that selection and delineation will be considered as optimal when reaching the best compromise between a too tight volume that could be associated to an unacceptable rate of local recurrence, and a too large volume, which could be associated to an unacceptable rate of treatment morbidity. Failure to do so have been reported to be associated to a higher risk of loco-regional recurrences and/or morbidity after treatment. In this framework, groups of experts proposed sets of guidelines for the radiation oncology community, aiming at standardizing radiotherapy practices of head and neck cancer patients. Although in constant improvement, such guidelines have been shown to translate into more consistent treatment approaches. This review article summarizes the knowledge accumulated over the years on target volume selection and delineation and tries to reconcile the various schools of thoughts on the topic.

Keywords: Head and neck tumors; IMRT; Neck nodes; Primary tumors; Target volumes.

Publication types

  • Review

MeSH terms

  • Consensus
  • Dose-Response Relationship, Radiation
  • Head and Neck Neoplasms / diagnostic imaging
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / radiotherapy*
  • Humans
  • Larynx / diagnostic imaging
  • Larynx / pathology
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology
  • Lymphatic Metastasis / diagnostic imaging
  • Lymphatic Metastasis / pathology
  • Lymphatic Metastasis / radiotherapy
  • Mouth / diagnostic imaging
  • Mouth / pathology
  • Neoplasm Recurrence, Local / prevention & control*
  • Pharynx / diagnostic imaging
  • Pharynx / pathology
  • Practice Guidelines as Topic
  • Radiation Oncology / methods
  • Radiation Oncology / standards*
  • Radiotherapy Dosage
  • Radiotherapy, Intensity-Modulated / methods
  • Radiotherapy, Intensity-Modulated / standards*
  • Squamous Cell Carcinoma of Head and Neck / diagnostic imaging
  • Squamous Cell Carcinoma of Head and Neck / pathology
  • Squamous Cell Carcinoma of Head and Neck / radiotherapy*
  • Tomography, X-Ray Computed
  • Tumor Burden / radiation effects