Potential advantage of studying the lymphatic drainage by sentinel node technique and SPECT-CT image fusion for pelvic irradiation of prostate cancer

Journal Article · Wed Nov 15 04:00:00 EST 2006 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2006.06.047· OSTI ID:20850226

Krengli, Marco ^[1]; Ballare, Andrea ^[1]; Cannillo, Barbara ^[2]; Rudoni, Marco ^[3]; Kocjancic, Ervin ^[4]; Loi, Gianfranco ^[2]; Brambilla, Marco ^[2]; Inglese, Eugenio ^[3]; Frea, Bruno ^[4]

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1. Department of Radiotherapy, University of Piemonte Orientale, Novara (Italy)
2. Department of Medical Physics, Hospital Maggiore della Carita, Novara (Italy)
3. Department of Nuclear Medicine, University of Piemonte Orientale, Novara (Italy)
4. Department of Urology, University of Piemonte Orientale, Novara (Italy)

Purpose: This study aims to investigate the in vivo drainage of lymphatic spread by using the sentinel node (SN) technique and single-photon emission computed tomography (SPECT)-computed tomography (CT) image fusion, and to analyze the impact of such information on conformal pelvic irradiation. Methods and Materials: Twenty-three prostate cancer patients, candidates for radical prostatectomy already included in a trial studying the SN technique, were enrolled. CT and SPECT images were obtained after intraprostate injection of 115 MBq of {sup 99m}Tc-nanocolloid, allowing identification of SN and other pelvic lymph nodes. Target and nontarget structures, including lymph nodes identified by SPECT, were drawn on SPECT-CT fusion images. A three-dimensional conformal treatment plan was performed for each patient. Results: Single-photon emission computed tomography lymph nodal uptake was detected in 20 of 23 cases (87%). The SN was inside the pelvic clinical target volume (CTV{sub 2}) in 16 of 20 cases (80%) and received no less than the prescribed dose in 17 of 20 cases (85%). The most frequent locations of SN outside the CTV{sub 2} were the common iliac and presacral lymph nodes. Sixteen of the 32 other lymph nodes (50%) identified by SPECT were found outside the CTV{sub 2}. Overall, the SN and other intrapelvic lymph nodes identified by SPECT were not included in the CTV{sub 2} in 5 of 20 (25%) patients. Conclusions: The study of lymphatic drainage can contribute to a better knowledge of the in vivo potential pattern of lymph node metastasis in prostate cancer and can lead to a modification of treatment volume with consequent optimization of pelvic irradiation.

• OSTI ID: 20850226
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 66; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
COMPUTERIZED TOMOGRAPHY
IMAGES
IN VIVO
INJECTION
IRRADIATION
LYMPH
LYMPH NODES
METASTASES
OPTIMIZATION
PATIENTS
PROSTATE
RADIATION DOSES
SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
TECHNETIUM 99
UPTAKE