The role of whole pelvic radiotherapy in locally advanced prostate cancer

Intensity-Modulated Radiotherapy of Pelvic Lymph Nodes in Locally Advanced Prostate Cancer: Planning Procedures and Early Experiences

“…The 2003 report from the RTOG 9413 study, which shows a clear benefit of lymph node irradiation for patients receiving adjuvant hormone therapy (5,8), should increase the use of pelvic RT for these patients, and hence should also highlight the need for lymph node treatment guidelines (29). In addition, noninvasive methods such as magnetic resonance imaging with superparamagnetic nanoparticle contrast, choline-positron emission tomography, and single photon emission computed tomography are now being used to define positive lymph nodes (7,(30)(31)(32)(33). It should therefore become possible to test further refinement in the dose prescription pattern for the lymph nodes that could be delivered with IMRT.…”

“…For prostate cancer patients at high risk for involvement of pelvic lymph nodes, the Radiation Therapy Oncology Group (RTOG) 9413 trial documented an improved progression-free survival for these patients if the pelvic lymph nodes were irradiated (5). Compared with localized fields, however, pelvic irradiation carries the risk of increasing adverse effects rates, in particular for the intestine (5)(6)(7)(8). Although the typical shape of the lymph node target calls for use of IMRT (with the planning target volume very close to the intestine), relatively few institutions have yet reported on the application of IMRT for this subset of prostate cancer patients (9)(10)(11)(12)(13)(14).…”

Dose–Volume Relationships for Acute Bowel Toxicity in Patients Treated With Pelvic Nodal Irradiation for Prostate Cancer

“…Although the optimal approach to the management of prostate cancer in patients at significant risk of pelvic lymph node involvement is still controversial, the practice of irradiating nodes in intermediate-and high-risk patients is expected to spread as the result of the recently published results of the Radiation Therapy Oncology Group (RTOG) 94-13 trial showing a significant benefit from the combination of irradiation of the pelvic lymph nodes with neoadjuvant and concurrent hormonal ablation (1)(2)(3). However, the incidence of acute and late gastrointestinal (GI) toxicity is increased in patients treated with conventional whole-pelvis irradiation (WPRT) because of the inclusion of a large volume of the bowel in the treatment field (1).…”

Ferumoxtran-10 MR Lymphography for Target Definition and Follow-up in a Patient Undergoing Image-Guided, Dose-Escalated Radiotherapy of Lymph Nodes upon PSA Relapse

“…In a similar effort, the French Genito-Urinary Group studied this question (GETUG-01) and also recently published negative results [19]. While whole pelvic radiotherapy with conventional techniques and doses <55 Gy does not lead to an increased survival rate in patients with high or intermediate risk of lymph node metastasis in prostate cancer [6,19], it definitely leads to increased toxicity [1].…”