Definition of lymph node areas for radiotherapy of prostate cancer: A critical literature review by the French Genito-Urinary Group and the French Association of Urology (GETUG-AFU).
OBJECTIVE
Recommendations for pelvic lymph node (LN) contouring rely on relatively dated studies that defined the Clinical Target Volume (CTV) of interest proposed for radiotherapy. The aim of this article was to review these recommendations with a critical analysis of published data on prostate cancer drainage.


METHODS
We performed a review of data on LN drainage in prostate cancer, based on anatomy texts and studies on lymphography, pelvic LN dissections, sentinel LN techniques, magnetic resonance imaging, computed tomography and functional imaging. We also present the GETUG experts' opinion, based on a survey on nodal CTV definition.


RESULTS
For lymphatic drainage of prostate cancers, pelvic LN areas classically considered are: distal common iliac, external iliac, internal iliac and obturator regions. Recently published data allow a mapping of sites at risk of pathological LN invasion. In 10-70% of cases, these sites are not included in the pelvic LN CTVs defined in consensuses. In accordance with other cooperative groups, the GETUG experts' survey showed that proximal common iliac, para-aortic, para-rectal and pre-sacral regions could include sites at risk of invasion in extended LN CTV, but were not considered in CTV contouring common practice. New recommendations are needed for nodal CTV in radiotherapy of prostate cancer.


CONCLUSIONS
The assessment of the efficacy and safety of LN radiotherapy is still the subject of several randomised studies. Whether or not meaningful results are obtained depends directly on the quality and homogeneity of the data analysed. A new consensus for delineation of LN regions appears necessary.
Department of Radiotherapy, Institut Bergonié, Comprehensive Cancer Centre, 33000 Bordeaux, France. Electronic address: p.sargos@bordeaux.unicancer.fr.
Paul
P
Sargos
Department of Radiotherapy, CHU de Poitiers, 86021 Poitiers, France.
Stéphane
S
Guerif
Department of Radiotherapy, Clinique Pasteur, 31300 Toulouse, France.
Igor
I
Latorzeff
Department of Radiotherapy, Hôpital Saint-Louis, 75010 Paris, France.
Christophe
C
Hennequin
Department of Radiotherapy, Centre Léon Bérard, Comprehensive Cancer Centre, F-69373 Lyon, France.
Pascal
P
Pommier
Department of Radiotherapy, CHU Mondor, 94010 Créteil, France.
Jean-Léon
JL
Lagrange
Department of Radiotherapy, Centre Georges-François Leclerc, Comprehensive Cancer Centre, 31000 Dijon, France.
Gilles
G
Créhange
Department of Radiotherapy, CHU de Lyon, 69002 Lyon, France.
Olivier
O
Chapet
Department of Radiotherapy, Centre Eugène Marquis, Comprehensive Cancer Centre, 35000 Rennes, France.
Renaud
R
de Crevoisier
Department of Radiotherapy, Institut du Cancer de Montpellier, Comprehensive Cancer Centre, 34298 Montpellier Cedex 5, France.
David
D
Azria
Department of Radiotherapy, Institut de Cancerologie de l'Ouest, Comprehensive Cancer Centre, 44805 Saint-Herblain Cedex, France.
Stéphane
S
Supiot
Unicancer, rue de Tolbiac, 75654 Paris Cedex 13, France.
Muriel
M
Habibian
Department of Urology, CHU de Toulouse, 31059 Toulouse Cedex 9, France.
Michel
M
Soulié
Department of Radiotherapy, Institut Bergonié, Comprehensive Cancer Centre, 33000 Bordeaux, France.
Pierre
P
Richaud
D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D015182:Lymphatic Irradiation / Q000379:methods*; D008220:Lymphography; D008297:Male; D010388:Pelvis; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011878:Radiotherapy / Q000379:methods; D011880:Radiotherapy Planning, Computer-Assisted; D021701:Sentinel Lymph Node Biopsy
Clinical Target Volume (CTV); Lymphatic drainage; Prostate cancer; Radiation therapy