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Войти в исследования Recommendations for postoperative radiotherapy in head & neck squamous cell carcinoma in the presence of flaps: A GORTEC internationally-reviewed HNCIG-endorsed consensus.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Carsuzaa Florent, Lapeyre Michel, Gregoire Vincent, Maingon Philippe, Beddok Arnaud, Marcy Pierre-Yves, Salleron Julia, Coutte Alexandre, Racadot Severine, Pointreau Yoann, Graff Pierre, Beadle Beth, Benezery Karen, Biau Julian, Calugaru Valentin, Castelli Joel, Chua Melvin, Di Rito Alessia, Dore Melanie, Ghadjar Pirus, Huguet Florence, Jardel Pauline, Johansen Jorgen, Kimple Randall, Krengli Marco, Laskar Sarbani, Mcdowell Lachlan, Nichols Anthony, Tribius Silke, Valduvieco Izaskun, Hu Chaosu, Liem Xavier, Moya-Plana Antoine, D'onofrio Ida, Parvathaneni Upendra, Takiar Vinita, Orlandi Ester, Psyrri Amanda, Shenouda George, Sher David, Steuer Conor, Shan Sun Xu, Tao Yungan, Thomson David, Tsai Mu-Hung, Vulquin Noemie, Gorphe Philippe, Mehanna Hisham, Yom Sue S, Bourhis Jean, Thariat Juliette
Аннотация
MATERIAL AND METHODS: Radiation, medical, and surgical oncologists were assembled from GORTEC and internationally with the Head and Neck Cancer International Group (HNCIG). The consensus-building approach covered 59 topics across four domains: (1) identification of postoperative tissue changes on imaging for flap delineation, (2) understanding of tumor relapse risks and target volume definitions, (3) functional radiation-induced deterioration, (4) feasibility of flap avoidance.
RESULTS: Across the 4 domains, international consensus (median score ≥ 7/9) was achieved only for functional deterioration (73.3%); other consensus rates were 55.6% for poRT avoidance of flap structures, 41.2% for flap definition and 11.1% for tumor spread patterns. Radiation-induced flap fibrosis or atrophy and their functional impact was well recognized while flap necrosis was not, suggesting dose-volume adaptation for the former. Flap avoidance was recommended to minimize bone flap osteoradionecrosis but not soft-tissue toxicity. The need for identification (CT planning, fiducials, accurate operative report) and targeting of the junction area at risk between native tissues and flap was well recognized. Experts variably considered flaps as prone to tumor dissemination or not. Discrepancies in rating of 11 items among international reviewing participants are shown.
CONCLUSION: International GORTEC and HNCIG-endorsed recommendations were generated for the management of flaps in head and neck radiotherapy. Considerable knowledge gaps hinder further consensus, in particular with respect to tumor spread patterns.