Department of Radiation Oncology, Radbound University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
Radiother Oncol. 2013 Jan;106(1):59-63. doi: 10.1016/j.radonc.2012.10.021. Epub 2012 Nov 27.
To investigate the pattern of lymph node spread on magnetic resonance lymphography (MRL) in prostate cancer patients and compare this pattern to the clinical target volume for elective pelvis irradiation as defined by the radiation therapy oncology group (RTOG-CTV).
The charts of 60 intermediate and high risk prostate cancer patients with non-enlarged positive lymph nodes on MRL were reviewed. Positive lymph nodes were assigned to a lymph node region according to the guidelines for delineation of the RTOG-CTV. Five lymph node regions outside this RTOG-CTV were defined: the para-aortal, proximal common iliac, pararectal, paravesical and inguinal region.
Fifty-three percent of the patients had an MRL-positive lymph node in a lymph node region outside the RTOG-CTV. The most frequently involved aberrant sites were the proximal common iliac, the pararectal and para-aortal region, which were affected in 30%, 25% and 18% respectively.
More than half of the patients had an MRL-positive lymph node outside the RTOG-CTV. To reduce geographical miss while minimizing the toxicity of radiotherapy, image based definition of an individual target volume seems to be necessary.
研究前列腺癌患者磁共振淋巴造影（MRL）上淋巴结转移的模式，并将其与放射治疗肿瘤学组（RTOG-CTV）定义的选择性骨盆照射的临床靶区（CTV）进行比较。
回顾了 60 例中高危前列腺癌患者的病历，这些患者在 MRL 上的淋巴结肿大呈阳性，但淋巴结无肿大。阳性淋巴结根据 RTOG-CTV 的勾画指南分配到淋巴结区域。在这个 RTOG-CTV 之外定义了五个淋巴结区域：腹主动脉旁、近端髂总、直肠旁、膀胱旁和腹股沟区。
53%的患者在 RTOG-CTV 之外的淋巴结区域有 MRL 阳性淋巴结。最常受累的异常部位是近端髂总、直肠旁和腹主动脉旁区域，分别受累 30%、25%和 18%。
超过一半的患者在 RTOG-CTV 之外有 MRL 阳性淋巴结。为了减少照射野的地理缺失，同时最大限度地降低放疗毒性，似乎需要基于图像定义个体化靶区。
