Determination and delineation of nodal target volumes for head-and-neck cancer based on patterns of failure in patients receiving definitive and postoperative IMRT
Determination and delineation of nodal target volumes for head-and-neck cancer based on patterns of failure in patients receiving definitive and postoperative IMRT
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DOI：
10.1016/s0360-3016(02)02881-x
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发表时间：
2002-08-01
影响因子：
7
通讯作者：
Dempsey, JF
中科院分区：
文献类型：
--
作者：
Chao, KSC;Wippold, FJ;Dempsey, JF
目的：我们提出的目标体积的确定和划定的头颈部淋巴结的基础上的模式的分析与调强放疗（IMRT）治疗的患者的淋巴结转移的指南。方法和材料：数据有关的自然过程中的每个头颈部癌的亚位点进行了审查。建立了一个系统，为节点靶体积的确定和描绘提供指导。根据这些指南，126例患者（52例确诊，74例术后）在1997年2月至2000年12月期间接受了头颈部癌调强放射治疗。中位随访时间为26个月（范围12-55），和模式的淋巴结failure.Results：这些准则定义的基础上的原发性肿瘤的位置和显微镜下转移到同侧和对侧（水平I-V）淋巴结区域的概率的淋巴结靶体积进行了分析。根据这些指南，在52例接受确定性IMRT的患者中，6例（12%）发现了持续或复发的淋巴结疾病，74例接受术后IMRT的患者中有7例（9%）在淋巴结区域失败。根据我们在头颈部肿瘤实施逆向计划调强放射治疗的临床经验，我们提出了一个简化的，但临床相关的指南，用于确定和描绘节点目标体积的方法。其目的是提供一个基础，使不同的机构在头颈部调强放射治疗的临床经验交流。当头颈部调强放射治疗的临床经验取得进展时，这些指南将受到进一步的完善。(C)2002年爱思唯尔科技有限公司
Purpose: We present the guidelines for target volume determination and delineation of head-and-neck lymph nodes based on the analysis of the patterns of nodal failure in patients treated with intensity-modulated radiotherapy (IMRT).Methods and Materials: Data pertaining to the natural course of nodal metastasis for each head-and-neck cancer subsite were reviewed. A system was established to provide guidance for nodal target volume determination and delineation. Following these guidelines, 126 patients (52 definitive, 74 postoperative) were treated between February 1997 and December 2000 with IMRT for head-and-neck cancer. The median follow-up was 26 months (range 12-55), and the patterns of nodal failure were analyzed.Results: These guidelines define the nodal target volume based on the location of the primary tumor and the probability of microscopic metastasis to the ipsilateral and contralateral (Level I-V) nodal regions. Following these guidelines, persistent or recurrent nodal disease was found in 6 (12%) of 52 patients receiving definitive IMRT, and 7 (9%) of 74 patients receiving postoperative IMRT had failure in the nodal region.Conclusion: On the basis of our clinical experience in implementing inverse-planning IMRT for head-and-neck cancer, we present guidelines using a simplified, but clinically relevant, method for nodal target volume determination and delineation. The intention was to provide a foundation that enables different institutions to exchange clinical experiences in head-and-neck IMRT. These guidelines will be subject to future refinement when the clinical experience in head-and-neck IMRT advances. (C) 2002 Elsevier Science Inc.