Lapeyre Michel, Pointreau Yoann, Alfonsi Marc, Boisselier Pierre, Biau Julian, Blanchard Pierre, Castelli Joël, Graff Pierre, Huguet Florence, Martin Laurent, Racadot Séverine, Sun Xu Shan, Tao Yungan, Bourhis Jean, Thariat Juliette
Department of Radiation Therapy, Jean Perrin Centre, 58 Rue Montalembert, BP 5026, 63011 Clermont Ferrand Cedex 1, France.
Department of Radiation Therapy, Inter-Regional Institute of Oncology (ILC, Institut inter-régionaL de Cancérologie), Jean Bernard Centre, Sarthe Oncology Centre 64 Rue de Degré 72000 Le Mans, France.
Clin Transl Radiat Oncol. 2025 May 20;53:100980. doi: 10.1016/j.ctro.2025.100980. eCollection 2025 Jul.
An international consensus was established in 2018 to standardise practice using geometric (5 + 5 mm) expansion around GTV-P for definitive radiotherapy of squamous cell carcinomas of the head and neck (HNC). The GORTEC (French HNC Oncology and Radiotherapy Group) conducted a survey to assess the level of agreement about CTV-P2 delineation using a "formalised consensus method".
The 32 proposals of the 2018 consensus on CTV-P2 and 6 additional GORTEC proposals were submitted to 13 GORTEC radiation oncologists (RO). Proposals were rated as "suitable" for median scores ≥7, "unsuitable" for scores ≤3.5 or "uncertain." The degree of agreement was high (≥85 %), moderate (75-84 %) or low (<75 %). Suitable proposals were reviewed by 40 other RO for final recommendations.
The 2018 proposals were "uncertain" with low degrees of agreement (41.5-69 %), except for T1 tumors, which had 89 % agreement. Five out of 6 GORTEC proposals were "suitable" and one "uncertain." The final recommendation was "suitable and to be retained" by 97.5 % of RO, as follows: To obtain CTV-P2, GORTEC recommends applying a "geo-anatomical" approach. Using the geometric concept, 10 mm-isotropic margins are applied to the GTV, for all locations but the hypopharynx (10 mm antero-posterior, laterally and 15 mm craniocaudally). CTV-P2 is further modified using the anatomical concept (anatomical barriers, dissemination routes) and accounting the benefit/risk balance and proximity of organs at risk.
The GORTEC survey derived from the 2018 international CTV-Ps delineation consensus suggests a "geo-anatomical" approach for the delineation of CTV-P2 in HNC.
2018年达成了一项国际共识，以规范在头颈部鳞状细胞癌（HNC）的根治性放射治疗中围绕GTV-P使用几何（5 + 5毫米）扩展的操作。法国头颈部肿瘤学和放射治疗组（GORTEC）进行了一项调查，以使用“形式化共识方法”评估关于CTV-P2勾画的一致程度。
将2018年关于CTV-P2的共识中的32项提议以及GORTEC的另外6项提议提交给13名GORTEC放射肿瘤学家（RO）。提议得分≥7时被评为“合适”，得分≤3.5时被评为“不合适”，得分在两者之间则为“不确定”。一致程度分为高（≥85%）、中（75 - 84%）或低（<75%）。合适的提议由另外40名RO进行审查以得出最终建议。
2018年的提议除T1肿瘤的提议一致程度为89%外，其他提议均为“不确定”且一致程度较低（41.5 - 69%）。GORTEC的6项提议中有5项“合适”，1项“不确定”。97.5%的RO给出的最终建议为“合适且应保留”，具体如下：为获得CTV-P2，GORTEC建议采用“地理 - 解剖学”方法。运用几何概念，除下咽外，在所有部位的GTV周围应用各向同性的10毫米边界（下咽的前后方向、横向为10毫米，头脚方向为15毫米）。CTV-P2进一步根据解剖学概念（解剖屏障、扩散途径）进行修正，并考虑获益/风险平衡以及危及器官的接近程度。
源自2018年国际CTV-P勾画共识的GORTEC调查表明，对头颈部癌中CTV-P2的勾画采用“地理 - 解剖学”方法。
