The Re-Emerging Role of Elective Pelvic Nodal Irradiation in High-Risk Node Negative Prostate Cancer

Abstract

The benefit of elective nodal irradiation (ENI) in combination with androgen deprivation therapy in high risk localized node negative prostate cancer has yet to be clearly defined. The potential gains in local control have been offset by the increased toxicity associated with pelvic radiotherapy, and recognition that historically the only trials to demonstrate a survival advantage in this group have been with androgen deprivation therapy. This review article considers the impact of pivotal randomized clinical trials conducted over the last thirty years on routine clinical practice, and how modern techniques may help to redefine radiotherapy as a necessary component for this group of patients.

Effective Organs-at-Risk Dose Sparing in Volumetric Modulated Arc Therapy Using a Half-Beam Technique in Whole Pelvic Irradiation

“…In addition, IMRT optimized to spare dose to pelvic bone marrow showed dosimetric benefits to reduce GI complications and hematological toxicities in anal and cervical cancer patients in WPRT ( 5 , 6 ). Although the benefits of WPRT in patients with locally advanced prostate cancer have been controversial ( 7 , 8 ), its role and gain have been reexamined considering the interaction between radiation therapy (RT) and adjuvant androgen deprivation therapy based on the duration and timing of hormone therapy and field size effect of RT ( 9 ). As per a new protocol, recent results also reported treatment gains in short-term androgen deprivation therapy plus pelvic lymph node irradiation in IMRT for prostate cancer ( 10 – 12 ).…”