Management of prostate cancer patients with lymph node involvement: A rapidly evolving paradigm

被引:44
作者
Crehange, Gilles [1 ,2 ]
Chen, Chien Peter [2 ]
Hsu, Charles C. [2 ]
Kased, Norbert [2 ]
Coakley, Fergus V. [3 ]
Kurhanewicz, John [3 ]
Roach, Mack, III [2 ]
机构
[1] Ctr Georges Francois Leclerc, Dept Radiat Oncol, F-21000 Dijon, France
[2] Univ Calif San Francisco, Helen Diller Family Comprehens Canc Ctr, Dept Radiat Oncol, San Francisco, CA 94143 USA
[3] Univ Calif San Francisco, Dept Radiol & Biomed Imaging, San Francisco, CA 94143 USA
关键词
Prostate cancer; Lymph node metastasis; Sentinel node; IMRT; IGRT; Fluorocholine PET/CT imaging; MR lymphangiography; SPECT/CT imaging; INTENSITY-MODULATED RADIOTHERAPY; PREDICT PATHOLOGICAL STAGE; EMISSION TOMOGRAPHY/COMPUTERIZED TOMOGRAPHY; TERM-FOLLOW-UP; RADICAL PROSTATECTOMY; RADIATION-THERAPY; HIGH-RISK; PELVIC LYMPHADENECTOMY; CLINICAL STAGE; GLEASON SCORE;
D O I
10.1016/j.ctrv.2012.05.005
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Although widespread PSA screening has inevitably led to increased diagnosis of lower risk prostate cancer, the number of patients with nodal involvement at baseline remains high (nearly 40% of high risk patients initially staged cNO). These rates probably do not reflect the true incidence of prostate cancer with lymph node involvement among patients selected for external beam radiotherapy (EBRT), as patients selected for surgery often have more favorable prognostic features. At many institutions, radical treatment directed only at the prostate is considered standard and patients known to have regional disease are often managed palliatively with androgen deprivation therapy (ADT) for presumed systemic disease. New imaging tools such as MR lymphangiography, choline-based PET imaging or combined SPECT/CT now allow surgeons and radiation oncologists to identify and target nodal metastasis and/or lymph nodes with a high risk of occult involvement. Recent advances in the field of surgery including the advent of extended nodal dissection and sentinel node procedures have suggested that cancer-specific survival might be improved for lymph-node positive patients with a low burden of nodal involvement when managed with aggressive interventions. These new imaging tools can provide radiation oncologists with maps to guide delivery of high dose conformal radiation to a target volume while minimizing radiation toxicity to non-target normal tissue. This review highlights advances in imaging and reports how they may help to define a new paradigm to manage node-positive prostate cancer patients with a curative-intent. (C) 2012 Elsevier Ltd. All rights reserved.
引用
收藏
页码:956 / 967
页数:12
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