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• W2528302834 abstract "Clinical trials evaluating the benefit of pelvic radiation therapy in the radiotherapeutic management of patients with higher risk prostate cancer have limited the superior field border to the S1/S2 or L5/S1 interspace. However, imaging and surgical series have demonstrated a high frequency of prostatic lymph node (LN) drainage beyond these landmarks. We aimed to determine the patterns of radiographically-defined abdomino-pelvic LN failures and their potential implications for pelvic radiation therapy field design in men who received dose escalated radiation therapy without pelvic LN irradiation. From 1992-2008, 2,694 patients with localized prostate cancer were treated with prostate/seminal vesicle only radiation therapy without pelvic LN treatment. One hundred-fifty six patients had their first failure within the abdominopelvic LNs, of which 60 had isolated failures within the pelvic LNs. A radiologist reviewed all imaging and mapped each LN failure to a template consisting of 34 abdomino-pelvic LN stations. Univariate and multivariate Cox regression analyses were performed to identify predictors of the likelihood of failure superior to the L5/S1 interspace. The median follow-up was 8.9 years. Of patients who recurred only in the pelvic LNs (n = 60), the common iliac LN station was involved in 55% (n = 33), including 10% (n = 6) having isolated common iliac LN failures. Using a pelvic radiation field superior border of L5/S1 would fully cover only 42% of these patients’ first recurrences whereas extending the field to L4/L5 would increase coverage to 93% of recurrences. Presence of T3/T4 disease and omission of androgen deprivation therapy both independently conferred an approximate 5-fold increase in the likelihood of having LN failure between L4/5 and L5/S1 in addition to standard pelvic field failures. Pelvic LN failures occur frequently superior to the commonly used L5/S1 landmark for pelvic radiation therapy coverage. The current RTOG 0924 trial is evaluating the benefit of pelvic radiation therapy with extended superior coverage to L4/5 when possible, which based on our data should significantly improve coverage of potential sites of failure." @default.
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• W2528302834 date "2016-10-01" @default.
• W2528302834 modified "2023-09-23" @default.
• W2528302834 title "Patterns of Lymph Node Failure After Dose-Escalated Radiation Therapy in Patients Who Did Not Undergo Pelvic Lymph Node Irradiation: Implications for Extended Pelvic Lymph Node Coverage" @default.
• W2528302834 doi "https://doi.org/10.1016/j.ijrobp.2016.06.1225" @default.
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