Recommendations for postoperative radiotherapy in head & neck squamous cell carcinoma in the presence of flaps: A GORTEC internationally-reviewed HNCIG-endorsed consensus - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Radiotherapy & Oncology Année : 2021

Recommendations for postoperative radiotherapy in head & neck squamous cell carcinoma in the presence of flaps: A GORTEC internationally-reviewed HNCIG-endorsed consensus

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Florent Carsuzaa
Michel Lapeyre
  • Fonction : Auteur
Vincent Gregoire
  • Fonction : Auteur
Philippe Maingon
Arnaud Beddok
Pierre-Yves Marcy
  • Fonction : Auteur
Julia Salleron
Severine Racadot
  • Fonction : Auteur
Yoann Pointreau
  • Fonction : Auteur
Pierre Graff
  • Fonction : Auteur
Beth Beadle
  • Fonction : Auteur
Karen Benezery
  • Fonction : Auteur
Julian Biau
  • Fonction : Auteur
Valentin Calugaru
Joel Castelli
  • Fonction : Auteur
Melvin Chua
  • Fonction : Auteur
Alessia Di Rito
  • Fonction : Auteur
Melanie Dore
  • Fonction : Auteur
Pirus Ghadjar
  • Fonction : Auteur
Florence Huguet
  • Fonction : Auteur
Pauline Jardel
  • Fonction : Auteur
Jorgen Johansen
  • Fonction : Auteur
Randall Kimple
  • Fonction : Auteur
Marco Krengli
  • Fonction : Auteur
Sarbani Laskar
  • Fonction : Auteur
Lachlan Mcdowell
  • Fonction : Auteur
Anthony Nichols
  • Fonction : Auteur
Silke Tribius
  • Fonction : Auteur
Izaskun Valduvieco
  • Fonction : Auteur
Chaosu Hu
  • Fonction : Auteur
Xavier Liem
Antoine Moya-Plana
  • Fonction : Auteur
Ida d'Onofrio
  • Fonction : Auteur
Upendra Parvathaneni
  • Fonction : Auteur
Vinita Takiar
  • Fonction : Auteur
Ester Orlandi
Amanda Psyrri
  • Fonction : Auteur
George Shenouda
  • Fonction : Auteur
David Sher
  • Fonction : Auteur
Conor Steuer
  • Fonction : Auteur
Xu Shan Sun
  • Fonction : Auteur
Yungan Tao
  • Fonction : Auteur
David Thomson
  • Fonction : Auteur
Mu-Hung Tsai
  • Fonction : Auteur
Noemie Vulquin
  • Fonction : Auteur
Philippe Gorphe
Hisham Mehanna
  • Fonction : Auteur
Sue S. Yom
  • Fonction : Auteur
Jean Bourhis
  • Fonction : Auteur
Juliette Thariat
  • Fonction : Auteur

Résumé

Introduction: Head and neck reconstructive surgery using a flap is increasingly common. Best practices and outcomes for postoperative radiotherapy (poRT) with flaps have not been specified. We aimed to provide consensus recommendations to assist clinical decision-making highlighting areas of uncertainty in the presence of flaps. 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. (c) 2021 Elsevier B.V. All rights reserved. Radiotherapy and Oncology 160 (2021) 140-147 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,

Dates et versions

hal-03600466 , version 1 (07-03-2022)

Identifiants

Citer

Florent Carsuzaa, Michel Lapeyre, Vincent Gregoire, Philippe Maingon, Arnaud Beddok, et al.. Recommendations for postoperative radiotherapy in head & neck squamous cell carcinoma in the presence of flaps: A GORTEC internationally-reviewed HNCIG-endorsed consensus. Radiotherapy & Oncology, 2021, 160, pp.140-147. ⟨10.1016/j.radonc.2021.04.026⟩. ⟨hal-03600466⟩

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