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Target Definition and Delineation CT/MRI/PET-Guided Targets

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Functional Preservation and Quality of Life in Head and Neck Radiotherapy

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Intensity-modulated radiation therapy (IMRT) has become more and more popular in head and neck radiotherapy. Its ability to generate complex-shaped and tight dose gradients between the targets and the surrounding organs at risk (OARs) brings an undeniable dosimetrical advantage over nonmodulated external-beam two-dimensional (2D) and threedimensional (3D) radiation techniques. This makes IMRT especially suitable to confi ne the prescribed high doses to the target volumes (TVs), limiting thus the dose delivered to the OARs.

Maximizing the therapeutic index by such technique however requires optimal and precise selection and delineation of both TVs and OARs. Indeed, incomplete TVs coverage may lead to marginal tumor recurrence, thus possibly compromising patient's outcome. On the other hand, overestimation of the TVs would potentially lead to an overdosage of normal tissues with a possible increase in complication probability. In this regard, clinicians may have different opinion on how to balance the risk of potentially missing part of the TVs and the risk of excessive normal tissue irradiation. This may account for some of the differences among physicians on how conservatively they delineate targets. This issue partially explains the large interobserver variability in both selecting and outlying the targets, these interobserver differences in these tasks surpassing physical dose coverage defi ciencies of the targets or dose uncertainties due to setup variations (Hong et al. 2004).

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Authors and Affiliations

  1. Radiation Oncology Department and Center for Molecular Imaging and Experimental Radiotherapy, Université Catholique de Louvain, St-Luc University Hospital, 10 Avenue Hippocrate, Bruxelles, 1200, Belgium

    Xavier Geets MD & Vincent Grégoire MD

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  1. Xavier Geets MD
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  2. Vincent Grégoire MD
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Editors and Affiliations

  1. Department of Human Oncology, University of Wisconsin School of Medicine, 600 Highland Avenue, K4/332, Madison, WI, 53792, USA

    P. M. Harari MD

  2. Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin Medical School, 600 Highland Avenue K4/711, Madison, WI, 53792-7375, USA

    N. P. Connor PhD

  3. Department of Oncology, Aarhus University Hospital, 44 Nøerrebrogade, Building 5, Aarhus C, DK-8000, Denmark

    C. Grau MD

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Geets, X., Grégoire, V. (2009). Target Definition and Delineation CT/MRI/PET-Guided Targets. In: Harari, P.M., Connor, N.P., Grau, C. (eds) Functional Preservation and Quality of Life in Head and Neck Radiotherapy. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-73232-7_14

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  • DOI: https://doi.org/10.1007/978-3-540-73232-7_14

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