Distribution of Prostate Sentinel Nodes: A SPECT-Derived Anatomic Atlas

Journal Article · Fri Apr 01 00:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.01.012· OSTI ID:21491689

Ganswindt, Ute ^[1]; Schilling, David ^[2]; Mueller, Arndt-Christian ^[3]; Bares, Roland ^[4]; Bartenstein, Peter ^[5]; Belka, Claus ^[1]

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1. Department of Radiation Oncology, Ludwig-Maximilians-University, Munich (Germany)
2. Department of Urology, University of Tuebingen, Tuebingen (Germany)
3. Department of Radiation Oncology, University of Tuebingen, Tuebingen (Germany)
4. Department of Nuclear Medicine, University of Tuebingen, Tuebingen (Germany)
5. Department of Nuclear Medicine, Ludwig-Maximilians-University, Munich (Germany)

Purpose: The randomized Radiation Therapy Oncology Group 94-13 trial revealed that coverage of the pelvic lymph nodes in high-risk prostate cancer confers an advantage (progression-free survival and biochemical failure) in patients with {>=}15% risk of lymph node involvement. To facilitate an improved definition of the adjuvant target volume, precise knowledge regarding the location of the relevant lymph nodes is necessary. Therefore, we generated a three-dimensional sentinel lymph node atlas. Methods and Materials: In 61 patients with high-risk prostate cancer, a three-dimensional visualization of sentinel lymph nodes was performed using a single photon emission computed tomography system after transrectal intraprostatic injection of 150 to 362 (median 295) mega becquerel (MBq) {sup 99m}Technetium-nanocolloid (1.5-3h after injection) followed by an anatomic functional image fusion. Results: In all, 324 sentinel nodes in 59 of 61 patients (96.7%) were detected, with 0 to 13 nodes per patient (median 5, mean 5.3). The anatomic distribution of the sentinel nodes was as follows: external iliac 34.3%, internal iliac 17.9%, common iliac 12.7%, sacral 8.6%, perirectal 6.2%, left paraaortic 5.3%, right paraaortic 5.3%, seminal vesicle lymphatic plexus 3.1%, deep inguinal 1.5%, superior rectal 1.2%, internal pudendal 1.2%, perivesical 0.9%, inferior rectal 0.9%, retroaortic 0.3%, superficial inguinal 0.3%, and periprostatic 0.3%. Conclusions: The distribution of sentinel nodes as detected by single photon emission computed tomography imaging correlates well with the distribution determined by intraoperative gamma probe detection. A lower detection rate of sentinels in close proximity to the bladder and seminal vesicles is probably caused by the radionuclide accumulation in the bladder. In regard to intensity-modulated radiotherapy techniques, the presented anatomic atlas may allow optimized target volume definitions.

• OSTI ID: 21491689
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 79, Issue 5; Other Information: DOI: 10.1016/j.ijrobp.2010.01.012; PII: S0360-3016(10)00110-0; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
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