Department of Radiation Oncology, Adana Dr. Turgut Noyan Research and Treatment Center, Baskent University, Faculty of Medicine, Adana, Turkey.
Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Radiother Oncol. 2020 Oct;151:222-227. doi: 10.1016/j.radonc.2020.08.021. Epub 2020 Aug 28.
To evaluate the distribution of metastatic lymph nodes (LN) detected on Ga-PSMA-positron emission tomography/computed tomography (PET/CT) in treatment-naïve prostate cancer (PC) patients and to analyze the LN coverage rates of the pelvic fields defined in the GETUG trial and RTOG guidelines and a pelvic field extending superiorly from the L4/L5 interspace.
Ga-PSMA-PET/CT images obtained at diagnosis of 138 PC patients were retrospectively analyzed. The number and locations of Ga-PSMA-positive LNs were co-registered with one single-planning CT. The numbers, locations, and sizes of LNs located outside the three pelvic volumes were investigated for the entire cohort and for patients with LN metastasis in the pelvic area only.
A total of 441 PSMA-PET-positive LN metastases were identified. The most frequent metastatic LNs were internal iliac LNs (25.2%). Para-aortic and presacral LNs outside the three pelvic fields were present in 20 (14.5%) and 22 patients (15.9%), respectively. The LN coverage rates according to the GETUG trial, the RTOG guidelines, and the pelvic field extending superiorly from L4/L5 were 44.2%, 52.2%, and 71, respectively, in the entire cohort and 51.7%, 61 and 83.1%, respectively, in patients with only pelvic LN metastasis. The number of metastatic LNs was a predictive factor for LNs located outside the three pelvic fields.
Extending the cranial margin of the pelvic field from L5/S1 to L4/L5 increases the accuracy of pelvic field irradiation in approximately 20% of patients, highlighting the importance of proximal common iliac irradiation, particularly in patients with multiple LN metastasis.
评估 Ga-PSMA 正电子发射断层扫描/计算机断层扫描（PET/CT）在未经治疗的前列腺癌（PC）患者中检测到的转移性淋巴结（LN）的分布，并分析 GETUG 试验和 RTOG 指南中定义的骨盆场以及从 L4/L5 间隙向上延伸的骨盆场的 LN 覆盖率。
回顾性分析了 138 例 PC 患者在诊断时获得的 Ga-PSMA-PET/CT 图像。Ga-PSMA 阳性 LN 的数量和位置与单个计划 CT 进行了共配准。研究了整个队列以及仅在盆腔区域有 LN 转移的患者中位于三个盆腔体积之外的 LN 的数量、位置和大小。
共发现 441 个 PSMA-PET 阳性 LN 转移。最常见的转移性 LN 是髂内 LN（25.2%）。在 20 名（14.5%）和 22 名（15.9%）患者中，存在腹主动脉旁和骶前 LN 位于三个骨盆场之外。根据 GETUG 试验、RTOG 指南和从 L4/L5 向上延伸的骨盆场，整个队列的 LN 覆盖率分别为 44.2%、52.2%和 71%，而仅在盆腔 LN 转移的患者中分别为 51.7%、61%和 83.1%。转移性 LN 的数量是位于三个骨盆场之外的 LN 的预测因素。
将骨盆场的颅侧边缘从 L5/S1 延伸到 L4/L5 可使大约 20%的患者骨盆场照射的准确性提高，突出了近端髂总照射的重要性，尤其是在多个 LN 转移的患者中。
