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Patterns of Lymph Node Failure after Dose-escalated Radiotherapy: Implications for Extended Pelvic Lymph Node
Daniel E Spratt1, Hebert A Vargas2, Zachary S Zumsteg3
1Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor 48109, USA.
European Urology
|August 16, 2016
Summary
Pelvic lymph node failures in prostate cancer often occur above standard radiotherapy field borders. Extending radiation fields to cover common iliac lymph nodes improves coverage of recurrence sites.
Area of Science:
- Radiation Oncology
- Medical Imaging
- Urologic Oncology
Background:
- Standard pelvic radiotherapy (PRT) field borders for higher-risk prostate cancer may not adequately cover all sites of lymph node (LN) drainage.
- Prostatic LN drainage patterns frequently extend beyond the commonly used L5/S1 interspace landmark.
Purpose of the Study:
- To investigate abdominopelvic LN failure patterns in patients with localized prostate cancer treated with radiotherapy.
- To assess the implications of these patterns for designing optimal PRT field borders.
Main Methods:
- Retrospective analysis of 2694 patients with localized prostate cancer treated with prostate/seminal vesicle-only radiotherapy.
- Radiographic review and mapping of 156 first abdominopelvic LN failures to 34 LN stations.
- Analysis of recurrence patterns in relation to PRT field borders and clinical factors.
Main Results:
- Pelvic LN failures occurred superior to the L5/S1 landmark in a significant proportion of patients (55% common iliac involvement).
- A superior PRT border at L5/S1 would cover only 42% of first pelvic LN recurrences; extending to common iliac stations improves coverage to 93%.
- T3/T4 disease and omission of androgen-deprivation therapy (ADT) were associated with increased risk of common iliac LN failure.
Conclusions:
- Pelvic LN failures commonly occur superior to the L5/S1 landmark, indicating inadequate coverage with standard PRT fields.
- Extending PRT superiorly to include common iliac LN stations is crucial for comprehensive treatment of higher-risk prostate cancer.
- ADT may offer protection against more superior LN failures, warranting further investigation.
