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  • [Anticancer Res.] Patterns of Recurrence After Salvage Radiotherapy Encompassing Pelvic Lymphatics in Men with High-risk Prostate Cancer.

    [Anticancer Res.] Patterns of Recurrence After Salvage Radiotherapy Encompassing Pelvic Lymphatics in Men with High-risk Prostate Cancer.

    울산의대 / 고민지, 김영석*

  • 출처
    Anticancer Res.
  • 등재일
    2018 Nov
  • 저널이슈번호
    38(11):6579-6584. doi: 10.21873/anticanres.13025.
  • 내용

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    Abstract
    BACKGROUND/AIM:
    The efficacy of adjuvant or salvage radiation to the regional lymph node area has not been fully investigated in high-risk prostate cancer patients; instead, radiotherapy is limited to the prostate fossa. The present study aimed to assess patterns of recurrence in prostate cancer patients with biochemical failure (BCF) who were treated with whole-pelvic salvage radiotherapy (SRT) following radical prostatectomy.

    PATIENTS AND METHODS:
    The clinical data from 196 high-risk prostate cancer patients who received SRT for BCF after radical prostatectomy were reviewed. BCF after SRT was detected in 80 patients, and 59 patients underwent imaging studies.

    RESULTS:
    Twenty four recurrences in 16 patients were identified, including 13 bone metastases, 6 vesicourethral anastomosis site recurrences, and 5 lymph node recurrences (one simultaneous with vesicourethral anastomosis). Regarding the treatment field, no in-field nodal recurrence was observed, whereas 4 out-of-field and 1 edge-of-field recurrences were detected.

    CONCLUSION:
    Locoregional recurrence was most common at the anastomosis site. Most nodal recurrences were located outside the pelvis, suggesting that elective pelvic nodal irradiation should be recommended in a selected patient population.

     


    Author information

    Koh M1, Kim YS2, Ahn H3, Kim CS3.
    1
    Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea.
    2
    Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea ysk@amc.seoul.kr.
    3
    Department of Urology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea.

  • 키워드
    Prostate cancer; pattern of failure; pelvic nodal irradiation; salvage radiotherapy
  • 연구소개
    전립선암으로 수술을 받는 환자들 중 1/4 이상에서 PSA가 상승하는 생화학적 재발을 보임. 이들에게 유일한 근치적 치료인 구제 방사선치료를 시행하고 있으며, 현재 표준은 전립선 수술부위에만 방사선치료를 하는 것임. 연구자들은 고위험군 전립선암환자들에게서 구제 방사선치료 시 전립선 수술부위 뿐만 아니라 골반 림프절을 포함하였음. 이에 따라 치료 부위 내 림프절 전이는 관찰되지 않았으며, 치료 부위 주변 또는 밖에서 림프절 전이가 관찰됨. 골전이를 제외하고는 요도 문합부에서 재발이 많았는데, 이는 방사선조사 선량을 증가해야 함을 시사함. 본 연구 결과는 향후 방사선치료 범위를 결정할 때 고려해야할 사항이며, 전향적 연구를 통해 결과를 확인할 필요가 있음.
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