Standardisation of Target Volume Delineation for Carotid-sparing Intensity-modulated Radiotherapy in Early Glottis Cancer

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• 作者：D.M. Gujral^&lowast ; ; M. Long^&dagger ; ; J.W.G. Roe^&Dagger ; ; K.J. Harrington^&lowast ; ; ^&sect ; ; C.M. Nutting^&lowast ; ; ^&sect ; ; ^{chris.nutting@rmh.nhs.uk}
• 关键词：Carotid sparing ; glottic cancer ; radiotherapy
• 刊名：Clinical Oncology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：29
• 期：1
• 页码：42-50
• 全文大小：400 K
• 卷排序：29

文摘

Recently, carotid-sparing intensity-modulated radiotherapy (IMRT) for early laryngeal glottis (T1/T2N0M0) cancer has generated interest in the hope of avoiding long-term carotid toxicity, as well as concerns relating to geographical misses and long-term normal tissue toxicity. The aim of this review was to summarise the current literature on carotid-sparing IMRT for early glottis cancer, with particular focus on definitions of target volumes and the carotid arteries as organs at risk. In addition, we make suggestions for standardisation of these structures, dose constraints and dose reporting.Materials and methodsFrom 73 references, 16 articles met the criteria for inclusion in this systematic review. These papers described two case reports, 11 planning studies and three prospective studies.ResultsThere was variation in all target volume definitions with no clear consensus. The greatest variability was in clinical target volume definition. Carotid artery and spinal cord delineation were not always defined and most studies did not use a carotid artery constraint. Of the eight studies that reported carotid artery delineation, no two studies delineated the same length of carotid artery, yet most studies reported mean doses. Most studies used IMRT with three to seven fields. Five studies used arc therapy and two studies used tomotherapy.ConclusionThis review highlights a lack of consensus in target volume definitions in carotid-sparing IMRT. Ultimately, long-term prospective data are required to show the benefit of carotid-sparing IMRT. Pooled data will prove useful as most studies will report on small numbers of patients. Therefore, adopting a consensus now on target volume definition, dose constraints and dose reporting will be crucial.