CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC,RTOG consensus guidelines.
OBJECTIVE
The appropriate application of 3-D CRT and IMRT for HNSCC requires a standardization of the procedures for the delineation of the target volumes. Over the past few years, two proposals--the so-called Brussels guidelines from Grégoire et al., and the so-called Rotterdam guidelines from Nowak et al.--emerged from the literature for the delineation of the neck node levels. Detailed examination of these proposals however revealed some important discrepancies.


METHODS
Within this framework, the Brussels and Rotterdam groups decided to review their guidelines and derive a common set of recommendations for delineation of neck node levels. This proposal was then discussed with representatives of major cooperative groups in Europe (DAHANCA, EORTC, GORTEC) and in North America (NCIC, RTOG), which, after some additional refinements, have endorsed them. The objective of the present article is to present the consensus guidelines for the delineation of the node levels in the node-negative neck.


CONCLUSIONS
First a short discussion of the discrepancies between the previous Brussels and the Rotterdam guidelines is presented. The general philosophy of the consensus guidelines and the methodology used to resolve the various discrepancies are then described. The consensus proposal is then presented and representative CTVs that are consistent with these guidelines are illustrated on CT sections. Last, the limitations of the consensus guidelines are discussed and some concerns about the direct applications of these guidelines to the node-positive neck and the post-operative neck are described.
Grégoire
Vincent
V
Radiation Oncology Dept. and Laboratory of Radiobiology, Université Catholique de Louvain, St-Luc University Hospital, B-1200 Brussels, Belgium.
Levendag
Peter
P
Ang
Kian K
KK
Bernier
Jacques
J
Braaksma
Marijel
M
Budach
Volker
V
Chao
Cliff
C
Coche
Emmanuel
E
Cooper
Jay S
JS
Cosnard
Guy
G
Eisbruch
Avraham
A
El-Sayed
Samy
S
Emami
Bahman
B
Grau
Cai
C
Hamoir
Marc
M
Lee
Nancy
N
Maingon
Philippe
P
Muller
Karin
K
Reychler
Hervé
H
D006258:Head and Neck Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes; D008207:Lymphatic Metastasis; D009333:Neck; D017410:Practice Guidelines as Topic