[Target volume for adjuvant radiotherapy after prostatectomy].
Although radical prostatectomy is an effective treatment for clinically localized prostate cancer, it fails in up to 20 to 40% of the cases. Local failure represents one of the possible patterns of relapse and is announced by detectable serum PSA levels. Patients at high risk for local relapse have extraprostatic disease, positive surgical margins or seminal vesicles infiltration at pathology. Three recently published phase III randomized clinical trials have clearly shown that, for these patients, immediate adjuvant irradiation reduces the risk of progression. For patients undergoing postoperative irradiation the standardisation of the target volume definition and delineation is required because no general consensus exists on "prostate bed" definition. The Genito-Urinary Working Party of the Radiation Oncology Group of the European Organization for the Research and treatment of cancer (ROG-EORTC) has developed a set of Guidelines to assist radiotherapists in the contouring of target volumes for postoperative irradiation: a consensus has been reached on a set of recommendations that are proposed to the radiation oncologist community. Emphasis has been put on the optimal cooperation between the surgeon, the pathologist and the radiotherapist in the frame of a multidisciplinary approach. Data on the presence and on the localization of extraprostaic extension and on positive surgical margins must be used. Placement of metallic clips in the tumor bed is of great help in localizing fixed anatomical sites as the anastomosis. The goal of such a document is to reduce inter-observer variability in target delineation in the framework of future clinical trials.
Bossi
A
A
Département de Radiothérapie, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805, Villejuif, France. alberto.bossi@igr.fr
D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D018450:Disease Progression; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014567:Urography
D017430:Prostate-Specific Antigen