Vogel Marco M E, Düsberg Mathias, Stöhrer Lucia, Dewes Sabrina, Sage Eva K, Borm Kai J, Gschwend Jürgen E, Eiber Matthias, Combs Stephanie E, Schiller Kilian
Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
Eur Urol Oncol. 2022 Dec;5(6):668-676. doi: 10.1016/j.euo.2022.09.006. Epub 2022 Oct 21.
Approximately 20-40% of patients with prostate cancer (PC) who undergo radical prostatectomy (RP) experience relapse, with the majority of these cases developing pelvic lymph node (LN) metastases. Taking new data from the prostate-specific membrane antigen (PSMA) positron emission tomography (PET) era into account, the Radiation Therapy Oncology Group (RTOG) 2009 contouring guideline for the pelvic LNs from 2009 was updated by the NRG Oncology group in 2020 (NRG 2020).
To evaluate and validate the updated NRG 2020 guideline with our established LN atlas.
DESIGN, SETTING, AND PARTICIPANTS: We screened 1653 PSMA PET/computed tomography (CT) data sets for patients with biochemical relapse who underwent a PET scan between November 2012 and November 2017. After screening, we developed an LN atlas using data from 233 patients.
We evaluated LN overlap (OL) with the RTOG 2009 and NRG 2020 contouring guidelines. OL was defined as within (>90%), partly within (10-90%), or outside (<10%).
In comparison to the RTOG 2009 guideline, 403 (52%), 134 (17%), and 241 (31%) of the LNs were not, were partly, or were fully covered within the overall group, respectively. By contrast, using the NRG 2020 guideline, 302 (39%), 190 (24%), and 286 (37%) of the LNs were not, were partly, or were fully covered, respectively (p < 0.001). Limitations include the retrospective design with missing data and no histopathological confirmation of the PET results.
The updated NRG 2020 contouring guideline improves coverage of the pelvic LNs in patients undergoing salvage radiation therapy. However, PET/CT should be considered whenever possible to ensure coverage of untypical LN spread.
We compared the 2009 and 2020 guidelines on the radiation area for the pelvis for patients with recurrent prostate cancer that has spread to lymph nodes. The newer guideline provides better coverage of pelvic lymph nodes than the older one and is useful in planning radiation therapy. However, a scan of the pelvis using the newest technique should be considered for individual patients to ensure coverage of untypical lymph nodes.
接受根治性前列腺切除术（RP）的前列腺癌（PC）患者中，约20%-40%会出现复发，其中大多数病例会发生盆腔淋巴结（LN）转移。考虑到前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）时代的新数据，放射治疗肿瘤学组（RTOG）2009年关于盆腔淋巴结的轮廓勾画指南于2020年由NRG肿瘤学组进行了更新（NRG 2020）。
用我们已建立的淋巴结图谱评估并验证更新后的NRG 2020指南。
设计、设置和参与者：我们筛选了1653例生化复发患者的PSMA PET/计算机断层扫描（CT）数据集，这些患者在2012年11月至2017年11月期间接受了PET扫描。筛选后，我们使用233例患者的数据建立了一个淋巴结图谱。
我们根据RTOG 2009和NRG 2020轮廓勾画指南评估淋巴结重叠（OL）情况。OL定义为在（>90%）、部分在（10%-90%）或不在（<10%）范围内。
与RTOG 2009指南相比，总体组中分别有403个（52%）、134个（17%）和241个（31%）淋巴结未被覆盖、部分被覆盖或完全被覆盖。相比之下，使用NRG 2020指南时，分别有302个（39%）、190个（24%）和286个（37%）淋巴结未被覆盖、部分被覆盖或完全被覆盖（p<0.001）。局限性包括回顾性设计且有数据缺失，以及PET结果无组织病理学确认。
更新后的NRG 2020轮廓勾画指南提高了接受挽救性放射治疗患者盆腔淋巴结的覆盖范围。然而，应尽可能考虑进行PET/CT检查，以确保非典型淋巴结扩散得到覆盖。
我们比较了2009年和2020年关于已扩散至淋巴结的复发性前列腺癌患者盆腔放射区域的指南。新指南比旧指南对盆腔淋巴结的覆盖更好，有助于放射治疗计划的制定。然而，对于个体患者，应考虑使用最新技术对盆腔进行扫描，以确保非典型淋巴结得到覆盖。
