title: Radiotherapy in Prostate Cancer Patients With Pelvic Lymphocele After Surgery: Clinical and Dosimetric Data of 30 Patients.
abstract: BACKGROUND
  The purpose of the study was to evaluate the feasibility of irradiation after prostatectomy in the presence of asymptomatic pelvic lymphocele.
  
  
  METHODS
  The inclusion criteria for this study were: (1) patients referred for postoperative (adjuvant or salvage) intensity modulated radiotherapy (IMRT; 66-69 Gy in 30 fractions); (2) detection of postoperative pelvic lymphocele at the simulation computed tomography [CT] scan; (3) no clinical symptoms; and (4) written informed consent. Radiotherapy toxicity and occurrence of symptoms or complications of lymphocele were analyzed. Dosimetric data (IMRT plans) and the modification of lymphocele volume during radiotherapy (cone beam CT [CBCT] scan) were evaluated.
  
  
  RESULTS
  Between January 2011 and July 2013, in 30 of 308 patients (10%) treated with radiotherapy after prostatectomy, pelvic lymphocele was detected on the simulation CT. The median lymphocele volume was 47 cm(3) (range, 6-467.3 cm(3)). Lymphocele was not included in planning target volume (PTV) in 8 cases (27%). Maximum dose to lymphocele was 57 Gy (range, 5.7-73.3 Gy). Radiotherapy was well tolerated. In all but 2 patients, lymphoceles remained asymptomatic. Lymphocele drainage-because of symptom occurrence-had to be performed in 2 patients during IMRT and in one patient, 7 weeks after IMRT. CBCT at the end of IMRT showed reduction in lymphocele volume and position compared with the initial data (median reduction of 37%), more pronounced in lymphoceles included in PTV.
  
  
  CONCLUSIONS
  Radiotherapy after prostatectomy in the presence of pelvic asymptomatic lymphocele is feasible with acceptable acute and late toxicity. The volume of lymphoceles decreased during radiotherapy and this phenomenon might require intermediate radiotherapy plan evaluation.
authors.affiliation: Division of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy. Electronic address: barbara.jereczek@ieo.it.
authors.forename: Barbara Alicja
authors.initials: BA
authors.lastname: Jereczek-Fossa
authors.affiliation: Division of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Sarah Pia
authors.initials: SP
authors.lastname: Colangione
authors.affiliation: Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Fodor
authors.affiliation: Division of Medical Physics, European Institute of Oncology, Milan, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Russo
authors.affiliation: Division of Medical Physics, European Institute of Oncology, Milan, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Cambria
authors.affiliation: Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Zerini
authors.affiliation: Division of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Bonora
authors.affiliation: Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Agnese
authors.initials: A
authors.lastname: Cecconi
authors.affiliation: National Center of Oncology Hadrontherapy (CNAO foundation), Pavia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Vischioni
authors.affiliation: Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vavassori
authors.affiliation: Division of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Deliu Victor
authors.initials: DV
authors.lastname: Matei
authors.affiliation: Division of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Bottero
authors.affiliation: Division of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Brescia
authors.affiliation: Division of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Musi
authors.affiliation: Division of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Mazzoleni
authors.affiliation: Division of Interventional Radiology, European Institute of Oncology, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Orsi
authors.affiliation: Division of Interventional Radiology, European Institute of Oncology, Milan, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Bonomo
authors.affiliation: Department of Health Sciences, University of Milan, Milan, Italy; Division of Urology, European Institute of Oncology, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: De Cobelli
authors.affiliation: Division of Radiation Oncology, European Institute of Oncology, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy; National Center of Oncology Hadrontherapy (CNAO foundation), Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
mesh_terms: D000368:Aged; D019583:Dose Fractionation, Radiation; D006801:Humans; D008210:Lymphocele / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000473:pathology* / Q000528:radiation effects; D011182:Postoperative Care; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Adjuvant radiotherapy; Lymphocele; Prostatectomy; Salvage radiotherapy; Toxicity