Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium.
Lancet Oncol. 2021 Aug;22(8):e348-e357. doi: 10.1016/S1470-2045(21)00242-4.
In patients with prostate cancer who have a high risk of pelvic nodal disease, the use of elective whole pelvis radiotherapy is still controversial. Two large, randomised, controlled trials (RTOG 9413 and GETUG-01) did not show a benefit of elective whole pelvis radiotherapy over prostate-only radiotherapy. In 2020, the POP-RT trial established the role of elective whole pelvis radiotherapy in patients who have more than a 35% risk of lymph node invasion (known as the Roach formula). POP-RT stressed the importance of patient selection. In patients with cN1 (clinically node positive) disease or pN1 (pathologically node positive) disease, the addition of whole pelvis radiotherapy to androgen deprivation therapy significantly improved survival compared with androgen deprivation therapy alone, as shown in large, retrospective studies. This patient population might increase in the future because use of the more sensitive prostate-specific membrane antigen PET-CT will become the standard staging procedure. Additionally, the SPORTT trial suggested a benefit of whole pelvis radiotherapy in biochemical recurrence-free survival in the salvage setting. A correct definition of the upper field border, which should include the bifurcation of the abdominal aorta, is key in the use of pelvic radiotherapy. As a result of using modern radiotherapy technology, severe late urinary and intestinal toxic effects are rare and do not seem to increase compared with prostate-only radiotherapy.
在患有高危盆腔淋巴结疾病的前列腺癌患者中，选择性全盆腔放疗的应用仍存在争议。两项大型随机对照试验（RTOG 9413 和 GETUG-01）并未显示选择性全盆腔放疗优于单纯前列腺放疗的益处。2020 年，POP-RT 试验确立了选择性全盆腔放疗在淋巴结侵犯风险超过 35%（称为 Roach 公式）的患者中的作用。POP-RT 强调了患者选择的重要性。在 cN1（临床淋巴结阳性）疾病或 pN1（病理淋巴结阳性）疾病患者中，与单独雄激素剥夺治疗相比，全盆腔放疗联合雄激素剥夺治疗显著提高了生存率，这在大型回顾性研究中得到了证实。由于更敏感的前列腺特异性膜抗原 PET-CT 将成为标准分期程序，未来这类患者人群可能会增加。此外，SPORTT 试验表明，在挽救性治疗中，全盆腔放疗对生化无复发生存有获益。正确定义上界，应包括腹主动脉分叉，这是盆腔放疗的关键。由于采用了现代放疗技术，严重的晚期尿和肠道毒性作用很少见，与单纯前列腺放疗相比似乎没有增加。
