TY - JOUR
T1 - Increased Frequency of Mesorectal and Perirectal LN Involvement in T4 Prostate Cancers
AU - Abu-Gheida, Ibrahim
AU - Bathala, Tharakeswara K.
AU - Maldonado, J. Alberto
AU - Khan, Mishal
AU - Anscher, Mitchell S.
AU - Frank, Steven Jay
AU - Choi, Seungtaek
AU - Nguyen, Quynh Nhu
AU - Hoffman, Karen E.
AU - McGuire, Sean Eric
AU - Kim, Minsoo
AU - Kuban, Deborah A.
AU - Aparicio, Ana
AU - Chapin, Brian Francis
AU - Tang, Chad
N1 - Funding Information:
This work was supported in part by Cancer Center Support (Core) Grant NCI CA016672 to The University of Texas MD Anderson Cancer Center.
Funding Information:
Disclosures: S.J.F. reports personal fees from Varian, grants and personal fees from C4 imaging, grants from Eli Lilly, grants from Elekta, grants and personal fees from Hitachi, other from Breakthrough Chronic Care, personal fees from Boston Scientific, and personal fees from National Comprehensive Cancer Network (NCCN), outside the submitted work. C.T. reports personal fees from Reflexion, AstraZeneca, and Wolter Kluwer, outside the submitted work. In addition, C.T. has a patent (US Patent #9,175,079) licensed to the Board of Trustees of the Leland Stanford Junior University.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Purpose: Patients with prostate cancer presenting with advanced T stage, mainly T4, might have a unique pattern of nodal failure and disease involvement that is not typically covered when local therapy is offered. We attempted to identify common sites of nodal disease presentation and failure for patients presenting with cT4 prostate cancer. Methods and Materials: All patients with treatment-naïve cT4 prostate cancer were retrospectively identified. All patients were required to have a confirmed diagnosis reviewed by our genitourinary pathologist and completed baseline staging. Lymph node (LN) involvement and location at diagnosis were reviewed by a genitourinary radiologist. All patients’ follow-up scans were also reviewed; based on LN size, imaging characteristics, and progression/regression characteristics on systemic therapy, the locations of sites of LN failure were recorded. For patients who underwent surgery, any pathologically involved LNs and their anatomic locations were recorded. A total of 103 patients met these criteria, with a median follow-up of 8 years (range, 0.5-14 years). Results: Rectal involvement by the primary disease was associated with a higher risk of perirectal and mesorectal LN involvement (45%) relative to no rectal involvement (26%) (P <.05). These echelons are typically not covered with conventional pelvic external beam radiation therapy and are not routinely part of pelvic LN dissection in patients treated surgically. Conversely, bladder or pelvic side wall invasion did not correlate with increased frequency of involvement of perirectal/mesorectal LNs (P >.05). Conclusions: When offering local therapy, target modification to include the perirectal and mesorectal LNs should be considered for patients presenting with T4 prostate cancer with rectal involvement.
AB - Purpose: Patients with prostate cancer presenting with advanced T stage, mainly T4, might have a unique pattern of nodal failure and disease involvement that is not typically covered when local therapy is offered. We attempted to identify common sites of nodal disease presentation and failure for patients presenting with cT4 prostate cancer. Methods and Materials: All patients with treatment-naïve cT4 prostate cancer were retrospectively identified. All patients were required to have a confirmed diagnosis reviewed by our genitourinary pathologist and completed baseline staging. Lymph node (LN) involvement and location at diagnosis were reviewed by a genitourinary radiologist. All patients’ follow-up scans were also reviewed; based on LN size, imaging characteristics, and progression/regression characteristics on systemic therapy, the locations of sites of LN failure were recorded. For patients who underwent surgery, any pathologically involved LNs and their anatomic locations were recorded. A total of 103 patients met these criteria, with a median follow-up of 8 years (range, 0.5-14 years). Results: Rectal involvement by the primary disease was associated with a higher risk of perirectal and mesorectal LN involvement (45%) relative to no rectal involvement (26%) (P <.05). These echelons are typically not covered with conventional pelvic external beam radiation therapy and are not routinely part of pelvic LN dissection in patients treated surgically. Conversely, bladder or pelvic side wall invasion did not correlate with increased frequency of involvement of perirectal/mesorectal LNs (P >.05). Conclusions: When offering local therapy, target modification to include the perirectal and mesorectal LNs should be considered for patients presenting with T4 prostate cancer with rectal involvement.
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U2 - 10.1016/j.ijrobp.2020.04.025
DO - 10.1016/j.ijrobp.2020.04.025
M3 - Article
C2 - 32353391
AN - SCOPUS:85085645315
SN - 0360-3016
VL - 107
SP - 982
EP - 985
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 5
ER -