title: Nodal Clearance Rate and Long-Term Efficacy of Individualized Sentinel Node-Based Pelvic Intensity Modulated Radiation Therapy for High-Risk Prostate Cancer.
abstract: OBJECTIVE
  To assess the efficacy of individual sentinel node (SN)-guided pelvic intensity modulated radiation therapy (IMRT) by determining nodal clearance rate [(n expected nodal involvement - n observed regional recurrences)/n expected nodal involvement] in comparison with surgically staged patients.
  
  
  METHODS
  Data on 475 high-risk prostate cancer patients were examined. Sixty-one consecutive patients received pelvic SN-based IMRT (5 × 1.8 Gy/wk to 50.4 Gy [pelvic nodes + individual SN] and an integrated boost with 5 × 2.0 Gy/wk to 70.0 Gy to prostate + [base of] seminal vesicles) and neo-/adjuvant long-term androgen deprivation therapy; 414 patients after SN-pelvic lymph node dissection were used to calculate the expected nodal involvement rate for the radiation therapy sample. Biochemical control and overall survival were estimated for the SN-IMRT patients using the Kaplan-Meier method. The expected frequency of nodal involvement in the radiation therapy group was estimated by imputing frequencies of node-positive patients in the surgical sample to the pattern of Gleason, prostate-specific antigen, and T category in the radiation therapy sample.
  
  
  RESULTS
  After a median follow-up of 61 months, 5-year OS after SN-guided IMRT reached 84.4%. Biochemical control according to the Phoenix definition was 73.8%. The nodal clearance rate of SN-IMRT reached 94%. Retrospective follow-up evaluation is the main limitation.
  
  
  CONCLUSIONS
  Radiation treatment of pelvic nodes individualized by inclusion of SNs is an effective regional treatment modality in high-risk prostate cancer patients. The pattern of relapse indicates that the SN-based target volume concept correctly covers individual pelvic nodes. Thus, this SN-based approach justifies further evaluation, including current dose-escalation strategies to the prostate in a larger prospective series.
authors: Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany. Electronic address: arndt-christian.mueller@med.uni-tuebingen.de.
authors: Arndt-Christian
authors: AC
authors: Müller
authors: Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany.
authors: Franziska
authors: F
authors: Eckert
authors: Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany.
authors: Frank
authors: F
authors: Paulsen
authors: Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany.
authors: Daniel
authors: D
authors: Zips
authors: Department of Urology, Eberhard Karls University, Tübingen, Germany.
authors: Arnulf
authors: A
authors: Stenzl
authors: Department of Urology, Eberhard Karls University, Tübingen, Germany.
authors: David
authors: D
authors: Schilling
authors: Department of Oncology, Aarhus University, Aarhus, Denmark.
authors: Markus
authors: M
authors: Alber
authors: Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University, Tübingen, Germany.
authors: Roland
authors: R
authors: Bares
authors: Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls University, Tübingen, Germany.
authors: Peter
authors: P
authors: Martus
authors: Department of Urology, Klinikum Augsburg, Augsburg, Germany.
authors: Dorothea
authors: D
authors: Weckermann
authors: Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
authors: Claus
authors: C
authors: Belka
authors: Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
authors: Ute
authors: U
authors: Ganswindt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D015182:Lymphatic Irradiation / Q000379:methods* / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000379:methods; D010388:Pelvis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen