Mapping of nodal disease in locally advanced prostate cancer: Rethinking the clinical target volume for pelvic nodal irradiation based on vascular rather than bony anatomy

Journal Article · Tue Nov 15 04:00:00 EST 2005 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2005.07.952· OSTI ID:20706274

Shih, Helen A ^[1]; Harisinghani, Mukesh ^[2]; Zietman, Anthony L ^[3]; Wolfgang, John A ^[3]; Saksena, Mansi ^[2]; Weissleder, Ralph ^[2]

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1. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States) and Center for Molecular Imaging Research, Department of Radiology, Massachusetts General Hospital, Boston, MA (United States)
2. Center for Molecular Imaging Research, Department of Radiology, Massachusetts General Hospital, Boston, MA (United States)
3. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

Purpose: Toxicity from pelvic irradiation could be reduced if fields were limited to likely areas of nodal involvement rather than using the standard 'four-field box.' We employed a novel magnetic resonance lymphangiographic technique to highlight the likely sites of occult nodal metastasis from prostate cancer. Methods and Materials: Eighteen prostate cancer patients with pathologically confirmed node-positive disease had a total of 69 pathologic nodes identifiable by lymphotropic nanoparticle-enhanced MRI and semiquantitative nodal analysis. Fourteen of these nodes were in the para-aortic region, and 55 were in the pelvis. The position of each of these malignant nodes was mapped to a common template based on its relation to skeletal or vascular anatomy. Results: Relative to skeletal anatomy, nodes covered a diffuse volume from the mid lumbar spine to the superior pubic ramus and along the sacrum and pelvic side walls. In contrast, the nodal metastases mapped much more tightly relative to the large pelvic vessels. A proposed pelvic clinical target volume to encompass the region at greatest risk of containing occult nodal metastases would include a 2.0-cm radial expansion volume around the distal common iliac and proximal external and internal iliac vessels that would encompass 94.5% of the pelvic nodes at risk as defined by our node-positive prostate cancer patient cohort. Conclusions: Nodal metastases from prostate cancer are largely localized along the major pelvic vasculature. Defining nodal radiation treatment portals based on vascular rather than bony anatomy may allow for a significant decrease in normal pelvic tissue irradiation and its associated toxicities.

• OSTI ID: 20706274
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 63; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANATOMY
CARCINOMAS
HEALTH HAZARDS
IRRADIATION
MAPPING
METASTASES
NMR IMAGING
PELVIS
PROSTATE
TOXICITY
VERTEBRAE