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Prostate cancer

Detecting lymph node metastases for personalized radiotherapy in patients with prostate cancer

Nature Reviews Urology volume 20, page 197 (2023)Cite this article

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Whole-pelvis radiotherapy (WPRT) for treatment of prostate cancer has demonstrated benefits over prostate-only radiotherapy (PORT) for patients with lymph node metastases. However, evidence for the benefits of WPRT is less conclusive for patients without these metastases. Additionally, WPRT has been suggested to result in increased genitourinary toxic effects compared with PORT. Therefore, identifying patients with lymph node metastases is important to enable targeted treatment with WPRT and avoid potential additional toxic effects in patients without node involvement. Different approaches to identifying node involvement are covered in two new studies published in European Urology Open Science and European Urology.

In a retrospective study involving 528 patients, de Barros and colleagues assessed the use of sentinel lymph node biopsy (SLNB) as a method of identifying patients with nodal metastases who would benefit from WPRT. Patients scheduled for radiotherapy at two centres (The Netherlands Cancer Institute (NCI) and Spaarne Gasthuis) from 2007 to 2018 were included. Patients at Spaarne Gasthuis did not undergo SLNB and all received PORT (non-SLNB group; n = 267), whereas patients at NCI underwent SLNB before receiving radiotherapy (SLNB group; n = 261). In the SLNB group, patients were assigned to receive WPRT if a sentinel node was identified as histologically positive (pN1), or PORT if a histologically negative node was identified.

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References

Original articles

  • de Barros, H. A. et al. Sentinel node procedure to select clinically localized prostate cancer patients with occult nodal metastases for whole pelvis radiotherapy. Eur. Urol. Open Sci. 49, 80–89 (2023)

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  • Fortuin, A. et al. Small suspicious lymph nodes detected on ultrahigh-field magnetic resonance imaging (MRI) in patients with prostate cancer with high risk of nodal metastases: the first in-patient study on ultrasmall superparamagnetic iron oxide-enhanced 7T MRI. Eur. Urol. https://doi.org/10.1016/j.eururo.2023.01.002 (2023)

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  1. Nature Reviews Urology http://www.nature.com/nrurol/

    Tim Thomas

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  1. Tim Thomas
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Correspondence to Tim Thomas.

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Thomas, T. Detecting lymph node metastases for personalized radiotherapy in patients with prostate cancer. Nat Rev Urol 20, 197 (2023). https://doi.org/10.1038/s41585-023-00753-y

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