Recommendations for pelvic lymph node (LN) contouring rely on relatively dated studies that defined the Clinical Target Volume (CTV) of interest proposed for radiotherapy. The aim of this article was to review these recommendations with a critical analysis of published data on prostate cancer drainage.
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We performed a review of data on LN drainage in prostate cancer, based on anatomy texts and studies on lymphography, pelvic LN dissections, sentinel LN techniques, magnetic resonance imaging, computed tomography and functional imaging. We also present the GETUG experts' opinion, based on a survey on nodal CTV definition.
For lymphatic drainage of prostate cancers, pelvic LN areas classically considered are: distal common iliac, external iliac, internal iliac and obturator regions. Recently published data allow a mapping of sites at risk of pathological LN invasion. In 10-70% of cases, these sites are not included in the pelvic LN CTVs defined in consensuses. In accordance with other cooperative groups, the GETUG experts' survey showed that proximal common iliac, para-aortic, para-rectal and pre-sacral regions could include sites at risk of invasion in extended LN CTV, but were not considered in CTV contouring common practice. New recommendations are needed for nodal CTV in radiotherapy of prostate cancer.
The assessment of the efficacy and safety of LN radiotherapy is still the subject of several randomised studies. Whether or not meaningful results are obtained depends directly on the quality and homogeneity of the data analysed. A new consensus for delineation of LN regions appears necessary.
Cancer treatment reviews. 2015 Oct 23 [Epub ahead of print]
Paul Sargos, Stéphane Guerif, Igor Latorzeff, Christophe Hennequin, Pascal Pommier, Jean-Léon Lagrange, Gilles Créhange, Olivier Chapet, Renaud de Crevoisier, David Azria, Stéphane Supiot, Muriel Habibian, Michel Soulié, Pierre Richaud
Department of Radiotherapy, Institut Bergonié, Comprehensive Cancer Centre, 33000 Bordeaux, France. Department of Radiotherapy, CHU de Poitiers, 86021 Poitiers, France. , Department of Radiotherapy, Clinique Pasteur, 31300 Toulouse, France. , Department of Radiotherapy, Hôpital Saint-Louis, 75010 Paris, France. , Department of Radiotherapy, Centre Léon Bérard, Comprehensive Cancer Centre, F-69373 Lyon, France. , Department of Radiotherapy, CHU Mondor, 94010 Créteil, France. , Department of Radiotherapy, Centre Georges-François Leclerc, Comprehensive Cancer Centre, 31000 Dijon, France. , Department of Radiotherapy, CHU de Lyon, 69002 Lyon, France. , Department of Radiotherapy, Centre Eugène Marquis, Comprehensive Cancer Centre, 35000 Rennes, France. , Department of Radiotherapy, Institut du Cancer de Montpellier, Comprehensive Cancer Centre, 34298 Montpellier Cedex 5, France. , Department of Radiotherapy, Institut de Cancerologie de l'Ouest, Comprehensive Cancer Centre, 44805 Saint-Herblain Cedex, France. , Unicancer, rue de Tolbiac, 75654 Paris Cedex 13, France. , Department of Urology, CHU de Toulouse, 31059 Toulouse Cedex 9, France. , Department of Radiotherapy, Institut Bergonié, Comprehensive Cancer Centre, 33000 Bordeaux, France.