New approaches for effective and safe pelvic radiotherapy in high-risk prostate cancer
AffiliationMount Vernon Cancer Centre, Northwood,UK
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AbstractRadical radiotherapy for prostate cancer offers excellent long-term outcomes for patients with high-risk disease. The increased risk of pelvic nodal involvement in this cohort has led to the development of whole-pelvis radiotherapy (WPRT) with a prostate boost. However, the use of WPRT remains controversial. Data are mixed, but advanced radiotherapy techniques enable delivery of increased radiation to pelvic nodes with acceptable levels of toxicity. Contemporary imaging modalities with increased sensitivity for detecting subclinical lymph node disease will facilitate selection of patients most likely to benefit from WPRT. Using such modalities for image guidance of advanced radiotherapy techniques could also permit high-dose delivery to nodes outside the conventional Radiation Therapy Oncol.ogy Group volumes, where magnetic resonance lymphography and single-photon-emission CT imaging have mapped a high frequency of microscopic disease. With increased toxicity a concern, an alternative to WPRT would be selective irradiation of target nodal groups most likely to harbour occult disease. New image-based 'big data' mining techniques enable the large-scale comparison of incidental dose distributions of thousands of patients treated in the past. By using novel computing methods and artificial intelligence, high-risk regions can be identified and used to optimize WPRT through refined knowledge of the likely location of subclinical disease.
CitationTharmalingam H, Choudhury A, van Herk M, McWilliam A, Hoskin PJ. New approaches for effective and safe pelvic radiotherapy in high-risk prostate cancer. Nat Rev Urol. 2019.
JournalNature Reviews Urology
- Magnetic resonance lymphography-guided selective high-dose lymph node irradiation in prostate cancer.
- Authors: Meijer HJ, Debats OA, Kunze-Busch M, van Kollenburg P, Leer JW, Witjes JA, Kaanders JH, Barentsz JO, van Lin EN
- Issue date: 2012 Jan 1
- Whole-pelvic nodal radiation therapy in the context of hypofractionation for high-risk prostate cancer patients: a step forward.
- Authors: Kaidar-Person O, Roach M 3rd, Créhange G
- Issue date: 2013 Jul 15
- Postoperative high-dose pelvic radiotherapy for N+ prostate cancer: toxicity and matched case comparison with postoperative prostate bed-only radiotherapy.
- Authors: Van Praet C, Ost P, Lumen N, De Meerleer G, Vandecasteele K, Villeirs G, Decaestecker K, Fonteyne V
- Issue date: 2013 Nov
- Postoperative elective pelvic nodal irradiation compared to prostate bed irradiation in locally advanced prostate cancer - a retrospective analysis of dose-escalated patients.
- Authors: Link C, Honeck P, Makabe A, Giordano FA, Bolenz C, Schaefer J, Bohrer M, Lohr F, Wenz F, Buergy D
- Issue date: 2019 Jun 7
- Survival Outcomes of Whole-Pelvic Versus Prostate-Only Radiation Therapy for High-Risk Prostate Cancer Patients With Use of the National Cancer Data Base.
- Authors: Amini A, Jones BL, Yeh N, Rusthoven CG, Armstrong H, Kavanagh BD
- Issue date: 2015 Dec 1