Department of Radiation Oncology [875], Radboud University Nijmegen Medical Centre, P O Box 9101, 6500 HB Nijmegen, The Netherlands.
Nat Rev Urol. 2013 Jul;10(7):376-85. doi: 10.1038/nrurol.2013.111. Epub 2013 May 28.
Controversy surrounds the benefit of whole pelvis radiotherapy (WPRT) over prostate-only radiotherapy (PORT) for intermediate-risk and high-risk patients with prostate cancer. In the PSA screening era, two large randomized trials as well as multiple retrospective studies comparing WPRT with PORT have been performed, albeit with contradictory results. Data regarding the use of WPRT in patients with biochemical recurrence after prostatectomy are scarce. As a consequence, the practice of WPRT varies worldwide. Advanced highly accurate imaging methods for the detection of lymph node metastases in patients with prostate cancer have been developed, such as PET, single photon emission computed tomography (SPECT), diffusion-weighted MRI and magnetic resonance lymphography (MRL). The use of these new imaging methods might improve nodal irradiation, as they can be used not only for selection of patients, but also for accurately determining the target volume to reduce geographical miss. Furthermore, these new techniques can enable dose escalation to involved lymph nodes.
争议围绕着全骨盆放疗（WPRT）与前列腺癌中高危患者单纯前列腺放疗（PORT）相比的优势。在 PSA 筛查时代，已经进行了两项大型随机试验以及多项比较 WPRT 与 PORT 的回顾性研究，但结果却相互矛盾。关于前列腺切除术后生化复发患者使用 WPRT 的数据很少。因此，WPRT 的应用在全球范围内存在差异。已经开发出了用于检测前列腺癌患者淋巴结转移的先进高精度成像方法，如 PET、单光子发射计算机断层扫描（SPECT）、扩散加权 MRI 和磁共振淋巴造影（MRL）。这些新的成像方法的应用可能会改善淋巴结照射，因为它们不仅可用于选择患者，还可用于准确确定靶区以减少地理缺失。此外，这些新技术可以使受累淋巴结的剂量升级。
