Fourati Nejla, Bacorro Warren, Nouri Omar, Agas Ryan Anthony, Larnaudie Audrey, Co Lester Bryan, Hammami Hela, Calma Clevelinda, Chua Melvin L K, Zhao Chong, Daoud Jamel, Mejia Michael Benedict
Department of Radiation Oncology, University of Sfax - Faculty of Medicine, EPS Habib Bourguiba, Sfax, Tunisia.
Department of Radiation Oncology, University of Santo Tomas Hospital - Benavides Cancer Institute, España Boulevard, Sampaloc, Manila, Philippines; Department of Clinical Epidemiology, University of Santo Tomas Faculty of Medicine and Surgery, España Boulevard, Sampaloc, Manila, Philippines.
Pract Radiat Oncol. 2025 Jul-Aug;15(4):347-366. doi: 10.1016/j.prro.2025.01.015. Epub 2025 Mar 26.
Induction chemotherapy (ICT), a new standard in the management of locally advanced nasopharyngeal carcinoma (NPC), is increasingly used in endemic regions. Radiation therapy (RT) target volume delineation protocols and dose level prescriptions vary significantly in the literature. High-level evidence to support a particular approach is currently lacking. We developed an international consensus guideline toward harmonizing practices based on a literature review and expert opinion.
The study entailed the following: consensus scope definition by focus group discussion (FGD); evidence gap identification by a scoping review of guidelines and literature reviews; evidence review and synthesis by a systematic review of experimental and observational studies and drafting of consensus statements by FGD; and consensus voting by modified Delphi process and FGD. The task force consisted of radiation oncologists from intermediate- and high-endemicity regions with expertise in treating NPC, evidence review, and consensus guideline development. The consensus panel consisted of relevant specialists from intermediate- and high-endemicity regions or with expertise in treating NPC. A modified e-Delphi method was used.
Four clinical situations after ICT for patients with NPC were selected for the consensus questions: optimal timing of chemoradiation; optimal imaging modalities for simulation and target volume delineation; optimal dose and fractionation; and RT target volume delineation. The consensus panel consisted of radiation oncologists (12), clinical oncologists (4), radiologists (3), a nuclear medicine specialist, medical physicists (2), and dosimetrists (2). The consensus guidelines were formulated after 2 rounds of Delphi voting and FGD; iterative revisions were made based on 2 rounds of internal review. The guidelines were subjected to external review and open commentary; further revisions were made if the consensus vote was not invalidated.
An international consensus guideline on delineating RT target volumes and corresponding dose levels in post-ICT NPC, as well as timing and modalities for imaging, was developed to help harmonize practices and enhance the comparability of interpretations of reported outcomes.
