title: CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC,RTOG consensus guidelines.
abstract: 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.
authors.affiliation: Radiation Oncology Dept. and Laboratory of Radiobiology, Université Catholique de Louvain, St-Luc University Hospital, B-1200 Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Grégoire
authors.forename: Peter
authors.initials: P
authors.lastname: Levendag
authors.forename: Kian K
authors.initials: KK
authors.lastname: Ang
authors.forename: Jacques
authors.initials: J
authors.lastname: Bernier
authors.forename: Marijel
authors.initials: M
authors.lastname: Braaksma
authors.forename: Volker
authors.initials: V
authors.lastname: Budach
authors.forename: Cliff
authors.initials: C
authors.lastname: Chao
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Coche
authors.forename: Jay S
authors.initials: JS
authors.lastname: Cooper
authors.forename: Guy
authors.initials: G
authors.lastname: Cosnard
authors.forename: Avraham
authors.initials: A
authors.lastname: Eisbruch
authors.forename: Samy
authors.initials: S
authors.lastname: El-Sayed
authors.forename: Bahman
authors.initials: B
authors.lastname: Emami
authors.forename: Cai
authors.initials: C
authors.lastname: Grau
authors.forename: Marc
authors.initials: M
authors.lastname: Hamoir
authors.forename: Nancy
authors.initials: N
authors.lastname: Lee
authors.forename: Philippe
authors.initials: P
authors.lastname: Maingon
authors.forename: Karin
authors.initials: K
authors.lastname: Muller
authors.forename: Hervé
authors.initials: H
authors.lastname: Reychler
mesh_terms: 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