International guideline on dose prioritization and acceptance criteria in radiation therapy planning for nasopharyngeal carcinoma Journal Article


Authors: Lee, A. W.; Ng, W. T.; Pan, J. J.; Chiang, C. L.; Poh, S. S.; Choi, H. C.; Ahn, Y. C.; AlHussain, H.; Corry, J.; Grau, C.; Grégoire, V.; Harrington, K. J.; Hu, C. S.; Kwong, D. L.; Langendijk, J. A.; Le, Q. T.; Lee, N. Y.; Lin, J. C.; Lu, T. X.; Mendenhall, W. M.; O'Sullivan, B.; Ozyar, E.; Peters, L. J.; Rosenthal, D. I.; Sanguineti, G.; Soong, Y. L.; Tao, Y.; Yom, S. S.; Wee, J. T.
Article Title: International guideline on dose prioritization and acceptance criteria in radiation therapy planning for nasopharyngeal carcinoma
Abstract: Purpose: The treatment of nasopharyngeal carcinoma requires high radiation doses. The balance of the risks of local recurrence owing to inadequate tumor coverage versus the potential damage to the adjacent organs at risk (OARs) is of critical importance. With advancements in technology, high target conformality is possible. Nonetheless, to achieve the best possible dose distribution, optimal setting of dose targets and dose prioritization for tumor volumes and various OARs is fundamental. Radiation doses should always be guided by the As Low As Reasonably Practicable principle. There are marked variations in practice. This study aimed to develop a guideline to serve as a global practical reference. Methods and Materials: A literature search on dose tolerances and normal-tissue complications after treatment for nasopharyngeal carcinoma was conducted. In addition, published guidelines and protocols on dose prioritization and constraints were reviewed. A text document and preliminary set of variants was circulated to a panel of international experts with publications or extensive experience in the field. An anonymized voting process was conducted to rank the proposed variants. A summary of the initial voting and different opinions expressed by members were then recirculated to the whole panel for review and reconsideration. Based on the comments of the panel, a refined second proposal was recirculated to the same panel. The current guideline was based on majority voting after repeated iteration for final agreement. Results: Variation in opinion among international experts was repeatedly iterated to develop a guideline describing appropriate dose prioritization and constraints. The percentage of final agreement on the recommended parameters and alternative views is shown. The rationale for the recommendations and the limitations of current evidence are discussed. Conclusions: Through this comprehensive review of available evidence and interactive exchange of vast experience by international experts, a guideline was developed to provide a practical reference for setting dose prioritization and acceptance criteria for tumor volumes and OARs. The final decision on the treatment prescription should be based on the individual clinical situation and the patient's acceptance of optimal balance of risk. © 2019 Elsevier Inc.
Keywords: tumors; patient treatment; nasopharyngeal carcinoma; dose distributions; treatment prescription; clinical situations; methods and materials; iterative methods; acceptance criteria; as low as reasonably practicable; international experts
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 105
Issue: 3
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2019-11-01
Start Page: 567
End Page: 580
Language: English
DOI: 10.1016/j.ijrobp.2019.06.2540
PUBMED: 31276776
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 October 2019 -- Source: Scopus
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MSK Authors
  1. Nancy Y. Lee
    622 Lee