title: Pelvic nodal radiotherapy in patients with unfavorable intermediate and high-risk prostate cancer: evidence, rationale, and future directions.
abstract: Over the past 15 years, there have been three major advances in the use of external beam radiotherapy in the management of men with clinically localized prostate made. They include: (1) image guided (IG) three-dimensional conformal/intensity modulated radiotherapy; (2) radiation dose escalation; and (3) androgen deprivation therapy. To date only the last of these three advances have been shown to improve overall survival. The presence of occult pelvic nodal involvement could explain the failure of increased conformality and dose escalation to prolong survival, because the men who appear to be at the greatest risk of death from clinically localized prostate cancer are those who are likely to have lymph node metastases. This review discusses the evidence for prophylactic pelvic nodal radiotherapy, including the key trials and controversies surrounding this issue.
authors.affiliation: The University of Texas, MD Anderson Cancer Center, USA.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Morikawa
authors.forename: Mack
authors.initials: M
authors.lastname: Roach
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D003952:Diagnostic Imaging / Q000379:methods; D005544:Forecasting; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D015182:Lymphatic Irradiation / Q000009:adverse effects / Q000379:methods*; D042601:Lymphatic Vessels / Q000033:anatomy & histology; D008297:Male; D010388:Pelvis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods*; D012306:Risk; D013737:Testis / Q000528:radiation effects; D013739:Testosterone / Q000097:blood
chemical_list: D000726:Androgen Antagonists; D013739:Testosterone; D017430:Prostate-Specific Antigen