New approaches for effective and safe pelvic radiotherapy in high-risk prostate cancer.,Nature Reviews Urology

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New approaches for effective and safe pelvic radiotherapy in high-risk prostate cancer.
Nature Reviews Urology ( IF 12.1 ) Pub Date : 2019-07-25 , DOI: 10.1038/s41585-019-0213-3
Hannah Tharmalingam ₁ , Ananya Choudhury _{2,

3} , Marcel Van Herk _{2,

3} , Alan McWilliam _{2,

3} , Peter J Hoskin _{1,

2,

3}

Affiliation

Radical radiotherapy for prostate cancer offers excellent long-term outcomes for patients with high-risk disease. The increased risk of pelvic nodal involvement in this cohort has led to the development of whole-pelvis radiotherapy (WPRT) with a prostate boost. However, the use of WPRT remains controversial. Data are mixed, but advanced radiotherapy techniques enable delivery of increased radiation to pelvic nodes with acceptable levels of toxicity. Contemporary imaging modalities with increased sensitivity for detecting subclinical lymph node disease will facilitate selection of patients most likely to benefit from WPRT. Using such modalities for image guidance of advanced radiotherapy techniques could also permit high-dose delivery to nodes outside the conventional Radiation Therapy Oncology Group volumes, where magnetic resonance lymphography and single-photon-emission CT imaging have mapped a high frequency of microscopic disease. With increased toxicity a concern, an alternative to WPRT would be selective irradiation of target nodal groups most likely to harbour occult disease. New image-based 'big data' mining techniques enable the large-scale comparison of incidental dose distributions of thousands of patients treated in the past. By using novel computing methods and artificial intelligence, high-risk regions can be identified and used to optimize WPRT through refined knowledge of the likely location of subclinical disease.

中文翻译：

在高危前列腺癌中进行有效，安全的盆腔放疗的新方法。

前列腺癌的根治性放射疗法为高危疾病患者提供了出色的长期结果。骨盆淋巴结受累的风险增加，导致了前列腺增高的全骨盆放疗（WPRT）的发展。但是，WPRT的使用仍存在争议。数据是混合的，但是先进的放射治疗技术能够以可接受的毒性水平将更多的放射线传递到盆腔淋巴结。具有更高的检测亚临床淋巴结疾病敏感性的当代影像学方法将有助于选择最有可能从WPRT中受益的患者。使用此类方法对先进的放射治疗技术进行图像指导还可以将大剂量的药物输送到常规放射治疗肿瘤学组之外的其他节点，那里的磁共振淋巴造影和单光子发射CT成像显示出了高频率的显微疾病。考虑到毒性增加，WPRT的替代方法是对最有可能隐匿性疾病的目标淋巴结群进行选择性照射。新的基于图像的“大数据”挖掘技术可以对过去治疗的数千名患者的偶然剂量分布进行大规模比较。通过使用新颖的计算方法和人工智能，可以通过对亚临床疾病的可能位置的精确了解来识别高风险区域并将其用于优化WPRT。WPRT的替代方法是对最有可能隐匿性疾病的目标淋巴结群进行选择性照射。新的基于图像的“大数据”挖掘技术可以对过去治疗的数千名患者的偶然剂量分布进行大规模比较。通过使用新颖的计算方法和人工智能，可以通过对亚临床疾病的可能位置的精确了解来识别高风险区域并将其用于优化WPRT。WPRT的替代方法是对最有可能隐匿性疾病的目标淋巴结群进行选择性照射。新的基于图像的“大数据”挖掘技术可以对过去治疗的数千名患者的偶然剂量分布进行大规模比较。通过使用新颖的计算方法和人工智能，可以通过对亚临床疾病的可能位置的精确了解来识别高风险区域并将其用于优化WPRT。

更新日期：2019-11-18

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