title: Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines.
abstract: In 2003, a panel of experts published a set of consensus guidelines for the delineation of the neck node levels in node negative patients (Radiother Oncol, 69: 227-36, 2003). In 2006, these guidelines were extended to include the characteristics of the node positive and the post-operative neck (Radiother Oncol, 79: 15-20, 2006). These guidelines did not fully address all nodal regions and some of the anatomic descriptions were ambiguous, thereby limiting consistent use of the recommendations. In this framework, a task force comprising opinion leaders in the field of head and neck radiation oncology from European, Asian, Australia/New Zealand and North American clinical research organizations was formed to review and update the previously published guidelines on nodal level delineation. Based on the nomenclature proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery, and in alignment with the TNM atlas for lymph nodes in the neck, 10 node groups (some being divided into several levels) were defined with a concise description of their main anatomic boundaries, the normal structures juxtaposed to these nodes, and the main tumor sites at risk for harboring metastases in those levels. Emphasis was placed on those levels not adequately considered previously (or not addressed at all); these included the lower neck (e.g. supraclavicular nodes), the scalp (e.g. retroauricular and occipital nodes), and the face (e.g. buccal and parotid nodes). Lastly, peculiarities pertaining to the node-positive and the post-operative clinical scenarios were also discussed. In conclusion, implementation of these guidelines in the daily practice of radiation oncology should contribute to the reduction of treatment variations from clinician to clinician and facilitate the conduct of multi-institutional clinical trials.
authors.affiliation: Cancer Center and Department of Radiation Oncology, Clinical and Experimental Research Institute, Université Catholique de Louvain, Cliniques Universitaires St-Luc, Brussels, Belgium. Electronic address: vincent.gregoire@uclouvain.be.
authors.forename: Vincent
authors.initials: V
authors.lastname: Grégoire
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: Kian
authors.initials: K
authors.lastname: Ang
authors.affiliation: Department of Radiation Oncology, University Hospital Düsseldorf, Germany.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Budach
authors.affiliation: Department of Oncology, Aarhus University Hospital, Denmark.
authors.forename: Cai
authors.initials: C
authors.lastname: Grau
authors.affiliation: Cancer Center and Department of Otorhinolaryngology, Head and Neck Surgery, Institut de Recherche Experimentale et Clinique, Université Catholique de Louvain, Cliniques Universitaires St-Luc, Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Hamoir
authors.affiliation: Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
authors.affiliation: Department of Clinical Oncology, The University of Hong Kong (Shenzhen) Hospital, China.
authors.forename: Anne
authors.initials: A
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Center, Stanford, USA; Radiation Therapy Oncology Group (RTOG), USA.
authors.forename: Quynh-Thu
authors.initials: QT
authors.lastname: Le
authors.affiliation: Department of Radiation Oncology, Centre Georges-François Leclerc, Dijon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Maingon
authors.affiliation: Department of Radiation Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Nutting
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.affiliation: Cancer Services, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: Sandro V
authors.initials: SV
authors.lastname: Porceddu
authors.affiliation: Cancer Center and Department of Human Anatomy and Plastic & Reconstructive Surgery, Institut de Recherche Experimentale et Clinique, Université Catholique de Louvain, Cliniques Universitaires St-Luc, Brussels, Belgium.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lengele
mesh_terms: D000328:Adult; D032921:Consensus; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D008198:Lymph Nodes / Q000033:anatomy & histology / Q000473:pathology* / Q000528:radiation effects; D008207:Lymphatic Metastasis; D009333:Neck / Q000033:anatomy & histology; D018787:Radiation Oncology / Q000379:methods / Q000592:standards*
keywords: Head and neck tumors; IMRT; Lymph node levels; Neck nodes; Worldwide consensus