Recommendations for postoperative radiotherapy in head & neck squamous cell carcinoma in the presence of flaps: A GORTEC internationally-reviewed HNCIG-endorsed consensus
Marcy, P. Y.
Di Rito, A.
Shan Sun, X.
Thomson, David J
Tsai, M. H.
Yom, S. S.
AffiliationDepartment of Head and Neck Surgery, CHU de Poitier, France
MetadataShow full item record
AbstractIntroduction: 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.
CitationCarsuzaa F, Lapeyre M, Gregoire V, Maingon P, Beddok A, Marcy P-Y, 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 and Oncology. 2021 Jul;160:140–7.
JournalRadiotherapy and Oncology
- Flap delineation guidelines in postoperative head and neck radiation therapy for head and neck cancers.
- Authors: Le Guevelou J, Bastit V, Marcy PY, Lasne-Cardon A, Guzene L, Gerard M, Larnaudie A, Coutte A, Beddok A, Calugaru V, Johnson A, Gery B, Liem X, Pointreau Y, Bourhis J, Thariat J, GORTEC.
- Issue date: 2020 Oct
- Postoperative radiotherapy after flap reconstructive surgery in patients with head and neck cancer: A retrospective monocentric study with flap delineation to assess toxicity and relapse.
- Authors: Gérard M, Le Guevelou J, Jacksic N, Lequesne J, Bastit V, Géry B, Jeanne C, Batalla A, Lacroix J, Kammerer E, Lasne-Cardon A, Thariat J
- Issue date: 2020 Dec
- Head and Neck Cancer International Group (HNCIG) Consensus Guidelines for the Delivery of Postoperative Radiation Therapy in Complex Cutaneous Squamous Cell Carcinoma of the Head and Neck (cSCCHN).
- Authors: Porceddu SV, Daniels C, Yom SS, Liu H, Waldron J, Gregoire V, Moore A, Veness M, Yao M, Johansen J, Mehanna H, Rischin D, Le QT
- Issue date: 2020 Jul 15
- Delineation of the primary tumour Clinical Target Volumes (CTV-P) in laryngeal, hypopharyngeal, oropharyngeal and oral cavity squamous cell carcinoma: AIRO, CACA, DAHANCA, EORTC, GEORCC, GORTEC, HKNPCSG, HNCIG, IAG-KHT, LPRHHT, NCIC CTG, NCRI, NRG Oncology, PHNS, SBRT, SOMERA, SRO, SSHNO, TROG consensus guidelines.
- Authors: Grégoire V, Evans M, Le QT, Bourhis J, Budach V, Chen A, Eisbruch A, Feng M, Giralt J, Gupta T, Hamoir M, Helito JK, Hu C, Hunter K, Johansen J, Kaanders J, Laskar SG, Lee A, Maingon P, Mäkitie A, Micciche' F, Nicolai P, O'Sullivan B, Poitevin A, Porceddu S, Składowski K, Tribius S, Waldron J, Wee J, Yao M, Yom SS, Zimmermann F, Grau C
- Issue date: 2018 Jan
- Free flap head and neck reconstruction: Feasibility in older patients.
- Authors: Parsemain A, Philouze P, Pradat P, Ceruse P, Fuchsmann C
- Issue date: 2019 Jul