Heterogeneity in head and neck IMRT target design and clinical practice

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• 作者：Theodore S. Hong^a ; Wolfgang A. Tomé ; ^b ; ^c ; ^d ; Paul M. Harari^b ; ^{harari@humonc.wisc.edu}
• 关键词：IMRT ; Head and neck ; Target design ; CTV definition ; Contouring
• 刊名：Radiotherapy and Oncology
• 出版年：2012
• 期刊代码：231_01678140
• 类别：med
• 出版时间：April, 2012
• 卷：103
• 期：1
• 页码：92-98
• 文件大小：789 K

摘要

Purpose

To assess patterns of H&N IMRT practice with particular emphasis on elective target delineation.

Materials and methods

Twenty institutions with established H&N IMRT expertise were solicited to design clinical target volumes for the identical H&N cancer case. To limit contouring variability, a primary tonsil GTV and ipsilateral level II node were pre-contoured. Participants were asked to accept this GTV, and contour their recommended CTV and PTV. Dose prescriptions, contouring time, and recommendations regarding chemotherapy were solicited.

Results

All 20 institutions responded. Remarkable heterogeneity in H&N IMRT design and practice was identified. Seventeen of 20 centers recommended treatment of bilateral necks whereas 3/20 recommended treatment of the ipsilateral neck only. The average CTV volume was 250 cm³ (range 37-676 cm³). Although there was high concordance in coverage of ipsilateral neck levels II and III, substantial variation was identified for levels I, V, and the contralateral neck. Average CTV expansion was 4.1 mm (range 0-15 mm). Eight of 20 centers recommended chemotherapy (cisplatin), whereas 12/20 recommended radiation alone. Responders prescribed on average 69 and 68 Gy to the tumor and metastatic node GTV, respectively. Average H&N target volume contouring time was 102.5 min (range 60-210 min).

Conclusion

This study identifies substantial heterogeneity in H&N IMRT target definition, prescription, neck treatment, and use of chemotherapy among practitioners with established H&N IMRT expertise. These data suggest that continued efforts to standardize and simplify the H&N IMRT process are desirable for the safe and effective global advancement of H&N IMRT practice.