Sentinel Node Procedure to Select Clinically Localized Prostate Cancer Patients with Occult Nodal Metastases for Whole Pelvis Radiotherapy

Barros, Hilda A. de; Duin, Jan J.; Mulder, Daan W.; Noort, Vincent van der; Noordzij, Marlies; Wit, Esther; Pos, Floris J.; Vogel, Wouter V.; Schaake, Eva E.; Leeuwen, F.W.B. van; Leeuwen, Pim J. van; Grivas, Nikolaos; Poel, Henk G. van der

doi:10.1016/j.euros.2022.12.011

Cited by 10 publications

(4 citation statements)

References 31 publications

(50 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a study by Hinsenveld et al, 100% sensitivity and 94% accuracy for para-aortic nodal staging were shown in patients with intermediate and high risk prostate cancer when sentinel node biopsy was added to PSMA-PET/CT imaging [ 18 ]. Another study by de Barros et al shows improved survival in patients when sentinel node biopsy was added to standard imaging to select pN1 patients with prostate cancer for pelvic radiotherapy [ 19 ]. Considering the similarities in the orderly spread of lymph node metastases in prostate and cervical cancer, comparable results could be expected in LACC.…”

Section: Discussionmentioning

confidence: 99%

Lymphatic mapping for image-guided radiotherapy in patients with locally advanced uterine cervical cancer: a feasibility study

et al. 2023

View full text Add to dashboard Cite

Background Lymph node metastasis is an important prognostic factor in locally advanced cervical cancer (LACC). No imaging method can successfully detect all (micro)metastases. This may result in (lymph node) recurrence after chemoradiation. We hypothesized that lymphatic mapping could identify nodes at risk and if radiation treatment volumes are adapted based on the lymphatic map, (micro)metastases not shown on imaging could be treated. We investigated the feasibility of lymphatic mapping to image lymph nodes at risk for (micro)metastases in LACC and assessed the radiotherapy dose on the nodes at risk. Methods Patients with LACC were included between July 2020 and July 2022. Inclusion criteria were: ≥ 18 years old, intended curative chemoradiotherapy, investigation under anesthesia. Exclusion criteria were: pregnancy and extreme obesity. All patients underwent abdominal MRI, [18F]FDG-PET/CT and lymphatic mapping after administration of 6–8 depots of 99mTc]Tc-nanocolloid followed by planar and SPECT/CT images 2–4 and 24 h post-injection. Results Seventeen patients participated. In total, 40 nodes at risk were visualized on the lymphatic map in 13/17 patients with a median of two [range 0–7, IQR 0.5–3] nodes per patient, with unilateral drainage in 4/13 and bilateral drainage in 9/13 patients. No complications occurred. The lymphatic map showed more nodes compared to suspicious nodes on MRI or [18F]FDG-PET/CT in 8/14 patients. Sixteen patients were treated with radiotherapy with 34 visualized nodes on the lymphatic map. Of these nodes, 20/34 (58.8%) received suboptimal radiotherapy: 7/34 nodes did not receive radiotherapy at all, and 13/34 received external beam radiotherapy (EBRT), but no simultaneous integrated boost (SIB). Conclusion Lymphatic mapping is feasible in LACC. Almost 60% of nodes at risk received suboptimal treatment during chemoradiation. As treatment failure could be caused by (micro)metastasis in some of these nodes, including nodes at risk in the radiotherapy treatment volume could improve radiotherapy treatment outcome in LACC. Trail registration The study was first registered at the International Clinical Trial Registry Platform (ICTRP) under number of NL9323 on 4 March 2021. Considering the source platform was not operational anymore, the study was retrospectively registered again on February 27, 2023 at CilicalTrials.gov under number of NCT05746156.

show abstract

Section: Discussionmentioning

confidence: 99%

Lymphatic mapping for image-guided radiotherapy in patients with locally advanced uterine cervical cancer: a feasibility study

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Furthermore, applying such a technique could also determine some influences in the field of radiation therapy. According to the recently published results by de Barros et al, SNB can be performed to stratify patients' risk to identify those with positive SLNs who are likely to benefit from an adjuvant radiation template, including pelvic nodes, and those who could safely undergo prostate-only treatment [65]. Recently, Berrens et al described a bimodal SLN hybrid-tracer procedure based on multi-fluorescence imaging [66].…”

Section: Conclusion and Future Prospectivesmentioning

confidence: 99%

Sentinel Lymph Node Biopsy in Prostate Cancer: An Overview of Diagnostic Performance, Oncological Outcomes, Safety, and Feasibility

Rossin,

Zorzi,

De Pablos-Rodríguez

et al. 2023

Diagnostics

View full text Add to dashboard Cite

Sentinel node biopsy (SNB) for prostate cancer (PCa) represents an innovative technique aimed at improving nodal staging accuracy. The routinary adoption of this procedure in patients undergoing radical prostatectomy (RP) might be crucial to identify candidates who could effectively benefit from extensive pelvic lymph nodal dissection (ePLND). Despite some promising results, SNB for PCa is still considered experimental due to the lack of solid evidence and procedural standardization. In this regard, our narrative review aimed to analyze the most recent literature in this field, providing an overview of both the diagnostic accuracy measures and the oncological outcomes of SNB.

show abstract

“…In addition, other RGS techniques might work in parallel. Sentinel lymph node biopsy can be proposed as additional tool for selecting patients who might benefit from wholepelvis radiotherapy after primary surgical treatment [19].…”

Section: Rgs With Single Photon Emitter Psma Radiopharmaceuticalsmentioning

confidence: 99%

Prostate-specific membrane antigen (PSMA) radioguided surgery in prostate cancer: An overview of current application and future perspectives

Muraglia

Mattana

Zuccotti

et al. 2023

Clin Transl Imaging

View full text Add to dashboard Cite

Radical prostatectomy (RP) with or without pelvic lymph node dissection (PLND) is the most frequent approach to treat men affected by prostate cancer (PCa), together with primary radiotherapy. Generally, patients performed computed tomography (CT) and bone scintigraphy to stage the disease prior to surgery. However, specific inhibitors directed to the prostate-specific membrane antigen (PSMA) have been recently proposed as radiopharmaceutical for positron emission tomography (PET) imaging. PSMA-PET proved higher diagnostic accuracy to stage high-risk PCa compared to conventional imaging, even if its impact on overall survival is yet to be confirmed. One of the main limitations for PSMA-PET in staging PCa is represented by the low sensitivity in identifying metastatic lymph node, namely in case of nodes smaller than 4–5 mm. Radioguided surgery (RGS) is based on the intraoperative detection of radiation emitted by the specific radiopharmaceutical. Recently, the possibility of performing RGS using cancer-specific radiotracer with high diagnostic accuracy (e.g. PSMA inhibitors) gained attention. In this review, we aimed to explore the value of PSMA-RGS in PCa, aimed at improving the surgery accuracy to remove nodal metastasis. Furthermore, we evaluated different radiation detectors (gamma rays probes vs. beta positron probes) and the diagnostic accuracy of these probes compared to PSMA-PET. A comprehensive literature review was performed in December 2022 with a non-systematic approach. After the first literature screening, a total of 16 studies have been selected and a comprehensive qualitative narrative synthesis of the articles has been performed. First studies showed promising results for PSMA-RGS, and prospective trials demonstrated good concordance of in vivo PSMA-positive detected nodes with histopathology analysis of the specimens. High sensitivity and specificity of the RGS approach were found. Whilst gamma probes have been more broadly explored, the clinical use of beta probes has been tested in feasibility studies only. Finally, Cerenkov luminescence imaging, micro-image guidance and augmented reality/virtual reality approaches in surgery are currently rising attention and are generating future perspectives for PSMA-guided surgery in PCa.

show abstract

Sentinel Node Procedure to Select Clinically Localized Prostate Cancer Patients with Occult Nodal Metastases for Whole Pelvis Radiotherapy

Cited by 10 publications

References 31 publications

Lymphatic mapping for image-guided radiotherapy in patients with locally advanced uterine cervical cancer: a feasibility study

Lymphatic mapping for image-guided radiotherapy in patients with locally advanced uterine cervical cancer: a feasibility study

Sentinel Lymph Node Biopsy in Prostate Cancer: An Overview of Diagnostic Performance, Oncological Outcomes, Safety, and Feasibility

Prostate-specific membrane antigen (PSMA) radioguided surgery in prostate cancer: An overview of current application and future perspectives

Contact Info

Product

Resources

About