Haute Couture or Ready-to-Wear? Tailored Pelvic Radiotherapy for Prostate Cancer Based on Individualized Sentinel Lymph Node Detection.

Autor: Michaud AV; Nuclear Medicine Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France., Samain B; Radiation Oncology Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France., Ferrer L; Medical Physics Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France.; CRCINA, University of Nantes and Angers, INSERM UMR1232, CNRS-ERL6001, France., Fleury V; Nuclear Medicine Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France., Doré M; Radiation Oncology Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France., Colombié M; Nuclear Medicine Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France., Dupuy C; Medical Physics Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France., Rio E; Radiation Oncology Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France., Guimas V; Radiation Oncology Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France., Rousseau T; Urologic Clinic Nantes-Atlantis, 44800 Saint-Herblain, France., Le Thiec M; Nuclear Medicine Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France., Delpon G; Medical Physics Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France.; CRCINA, University of Nantes and Angers, INSERM UMR1232, CNRS-ERL6001, France., Rousseau C; Nuclear Medicine Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France.; CRCINA, University of Nantes and Angers, INSERM UMR1232, CNRS-ERL6001, France., Supiot S; Radiation Oncology Department, Institut de Cancérologie de l'Ouest, 44805 Nantes Saint-Herblain, France.; CRCINA, University of Nantes and Angers, INSERM UMR1232, CNRS-ERL6001, France.
Jazyk: angličtina
Zdroj: Cancers [Cancers (Basel)] 2020 Apr 10; Vol. 12 (4). Date of Electronic Publication: 2020 Apr 10.
DOI: 10.3390/cancers12040944
Abstrakt: Prostate cancer (PCa) pelvic radiotherapy fields are defined by guidelines that do not consider individual variations in lymphatic drainage. We examined the feasibility of personalized sentinel lymph node (SLN)-based pelvic irradiation in PCa. Among a SLN study of 202 patients, we retrospectively selected 57 patients with a high risk of lymph node involvement. Each single SLN clinical target volume (CTV) was individually segmented and pelvic CTVs were contoured according to Radiation Therapy Oncology Group (RTOG) guidelines. We simulated a radiotherapy plan delivering 46 Gy and calculated the dose received by each SLN. Among a total of 332 abdominal SLNs, 305 pelvic SLNs (beyond the aortic bifurcation) were contoured (mean 5.4/patient). Based on standard guidelines, CTV missed 67 SLNs (22%), mostly at the common iliac level (40 SLNs). The mean distance between iliac vessels and the SLN was 11mm, and despite a 15mm margin around the iliac vessels, 9% of SLNs were not encompassed by the CTV. Moreover, 42 SLNs (63%) did not receive 95% of the prescribed dose. Despite a consensus on contouring guidelines, a significant proportion of SLNs were not included in the pelvic CTV and did not receive the prescribed dose. A tailored approach based on individual SLN detection would avoid underdosing pelvic lymph nodes that potentially contain tumor cells.
Databáze: MEDLINE
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