Individualized image-based lymph node irradiation for prostate cancer

• Published in: Nature reviews. Urology Vol. 10; no. 7; pp. 376 - 385
• Main Authors: Meijer, Hanneke J. M., Debats, Oscar A., Th. van Lin, Emile N. J., van Vulpen, Marco, Witjes, J. Alfred, Oyen, Wim J. G., Barentsz, Jelle O., Kaanders, Johannes H. A. M.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.07.2013; Nature Publishing Group
• Subjects: 631/250/1620/1616; 692/699/2768/589/466; 692/699/67/322; 692/700/565/485; Cancer therapies; Care and treatment; Diagnosis; Diagnosis, Radioscopic; Diagnostic Imaging - methods; Disease-Free Survival; Dissection; Humans; Lymph Nodes - radiation effects; Lymphatic Irradiation; Lymphatic Metastasis; Lymphatic system; Male; Medicine; Medicine & Public Health; Metastasis; Methods; Oncology; Patient outcomes; Pelvis - pathology; Pelvis - radiation effects; Prostate cancer; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - secondary; Radiation therapy; Radiotherapy; Randomized Controlled Trials as Topic - methods; review-article; Urology
• ISSN: 1759-4812; 1759-4820
• DOI: 10.1038/nrurol.2013.111

Meijer and colleagues review recent imaging advances to detect cancerous nodes in patients with prostate cancer. Improved detection of involved nodes enable a more personalized approach in patient selection and treatment planning for lymph node irradiation. Controversy surrounds the benefit of whole pelvis radiotherapy (WPRT) over prostate-only radiotherapy (PORT) for intermediate-risk and high-risk patients with prostate cancer. In the PSA screening era, two large randomized trials as well as multiple retrospective studies comparing WPRT with PORT have been performed, albeit with contradictory results. Data regarding the use of WPRT in patients with biochemical recurrence after prostatectomy are scarce. As a consequence, the practice of WPRT varies worldwide. Advanced highly accurate imaging methods for the detection of lymph node metastases in patients with prostate cancer have been developed, such as PET, single photon emission computed tomography (SPECT), diffusion-weighted MRI and magnetic resonance lymphography (MRL). The use of these new imaging methods might improve nodal irradiation, as they can be used not only for selection of patients, but also for accurately determining the target volume to reduce geographical miss. Furthermore, these new techniques can enable dose escalation to involved lymph nodes. Key Points Elective lymph node irradiation is currently limited by the lack of sensitive imaging methods for the detection of lymph node metastases These limitations might account for the disappointing results of this treatment in clinical trials, owing to suboptimal selection of patients, target volume definition and radiation dose New, highly accurate imaging methods have been developed that enable individualized image-based irradiation of target volumes as well as a boost dose to positive lymph nodes These new techniques are likely to redefine the role of lymph node irradiation in prostate cancer treatment and improve clinical outcomes