How, if at all, has the new DAHANCA H&N contouring guidelines changed how you delineate low dose CTV (CTV-P2) for head and neck cancer primaries?

Topics: Head and Neck Cancers • Radiation Oncology

Should any additional anatomical areas be intentionally included in CTV-P2 if it goes beyond the "5+5" expansion? The text (found here:https://www.ncbi.nlm.nih.gov/pubmed/29180076) states that the PTV-P2 "may" or "likely" extend extend through certain structures but do not specify that these structures should be intentionally included if they go beyond the standard 10mm expansion.

Are people in the US dropping anatomy based CTVs (eg for tonsil primaries - ipsilateral soft palate, ipsilateral base of the tongue, ipsilateral glossotonsillar sulcus. Superiorly, ipsilateral pharynx superiorly to pterygoid plate)? Do people stick with these recommendations only for T1/2 and not T3/4?

Answer from: Radiation Oncologist at Academic Institution

I think it is important to keep anatomical boundaries for head and neck cancer. To depart from that is problematic for the primary disease site. My subclinical region always takes into account the anatomical likely site of spread. The 5 by 5 rule that the consensus guideline referenced is an old sch...

Comments

Radiation Oncologist at West Michigan Cancer Center
Look forward to your excellent book.

Radiation Oncologist at Icahn School of Medicine at Mount Sinai
I am increasingly shrinking my CTV margins (outsid...

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