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[Expected benefit of lymph node and seminal vesical dissection to decrease high-risk prostate cancer radiotherapy].

J Colliaux1, L Kharchi2, S Vincendeau3

  • 1Département de radiothérapie, centre régional de lutte contre le cancer Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; Université de Rennes 1, centre investigation clinique, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35000 Rennes, France.

Cancer Radiotherapie : Journal De La Societe Francaise De Radiotherapie Oncologique
|June 27, 2016
PubMed
Summary

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Reducing the target volume in prostate cancer intensity-modulated radiotherapy, after lymph node and seminal vesicle dissection, significantly lowers rectal and bladder doses. This approach decreases the risk of digestive toxicity, improving patient outcomes.

Area of Science:

  • Radiation Oncology
  • Urologic Oncology
  • Medical Physics

Background:

  • Prostate cancer treatment often involves intensity-modulated radiotherapy (IMRT).
  • Pelvic lymph node and seminal vesicle dissection are surgical procedures preceding radiotherapy.
  • Optimizing target volume in IMRT is crucial for minimizing toxicity.

Purpose of the Study:

  • To evaluate the dosimetric benefits of reducing the target volume in prostate cancer IMRT.
  • To assess the impact of including seminal vesicles and lymph nodes on target volume.
  • To quantify the reduction in radiation dose to organs at risk with smaller target volumes.

Main Methods:

  • Retrospective analysis of 25 high-risk prostate cancer patients treated with surgery followed by IMRT.
Keywords:
Cancer prostatiqueCurage pelvienIMRTLymph node dissectionProstate cancerRCMI

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  • Simulation of four treatment planning scenarios with varying target volumes: prostate-seminal vesicles-lymph nodes, prostate-lymph nodes, prostate-seminal vesicles, and prostate only.
  • Dose-volume histograms and risk of late toxicity were analyzed for each plan.
  • Main Results:

    • Including seminal vesicles and lymph nodes increased the target volume by factors of 1.6 and 6.5, respectively.
    • Reducing the target volume from prostate-seminal vesicles-lymph nodes to prostate only decreased rectal mean dose from 49Gy to 36Gy.
    • This reduction also decreased the risk of late rectal bleeding (4.4% to 2.4%) and bladder wall mean dose (51Gy to 35Gy).
    • Excluding lymph nodes reduced the absolute risk of diarrhea by 11%.

    Conclusions:

    • Pelvic lymph node and seminal vesicle dissection prior to prostate cancer IMRT allows for target volume reduction.
    • This strategy leads to a moderate decrease in the risk of digestive toxicity.
    • Optimizing target volumes in IMRT can improve treatment tolerance and patient outcomes.