Delineation of the post-operative primary tumour and nodal clinical target volumes in oral cavity squamous cell carcinoma: European Society for Radiotherapy and Oncology (ESTRO) clinical guidelines
Bibliographic record
Abstract
BACKGROUND AND PURPOSE: To date, no consensus guidelines have been published that systematically guide delineation of primary and nodal Clinical Target Volumes (CTVs) in patients who require post-operative radiotherapy (PORT) for mucosal Head and Neck squamous cell carcinoma (HNSCC). As a result, significant individual, institutional and national variation exists in the way that CTVs are delineated in the post-operative setting, leading to considerable heterogeneity in radiotherapy treatment. METHODS: A multi-disciplinary group of experts convened by the European Society for Radiotherapy and Oncology (ESTRO) set-out principles for the multi-disciplinary management of oral cavity squamous cell carcinoma (OCSCC). Building on these, and adapting the geometric expansion approach described in previous primary CTV delineation guidelines, new consensus guidelines for the delineation of post-operative CTVs, both for the primary tumour and nodal regions, were proposed by the expert group, before being shared with a second tier of international experts to ensure their worldwide acceptability and applicability. RESULTS: These guidelines propose that surrogate volumes representing the resected primary and nodal Gross Tumour Volumes (GTV-P and GTV-N respectively) are re-created on the radiotherapy planning scan, either by registration with diagnostic imaging or via reference to anatomical landmarks. A post-operative CTV for the primary tumour (CTV-P) is created as a composite volume that includes: i) geometric expansion around the surrogate GTV-P, and ii) geometric expansion around the surgical defect and/or reconstruction flap. A post-operative CTV for the nodal region (CTV-N) is created as a composite volume that includes: i) geometric expansion around the surrogate GTV-N, and ii) the involved nodal level (CTV-N1). Guidelines for delineating at-risk nodal levels in a prophylactic dose CTV (CTV-N2) are included, and for making decisions regarding the need for unilateral and/or bilateral neck treatment. CONCLUSIONS: Implementation of these guidelines into clinical practice should reduce variation, and by promoting consistency of approach, facilitate multi-institutional audits and clinical trials including Radiation Therapy Quality Assurance (RTQA) in patients with OCSCC. It is anticipated that they will form the basis for future guidelines aiming to standardise post-operative CTV delineation in other head and neck subsites.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.019 | 0.021 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.005 | 0.003 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".