淋巴结阳性前列腺癌的放射治疗:目前的证据和未来的方向

IF 3.2 3区 医学 Q3 ONCOLOGY
Michael Melton , Antonio Angrisani , Andrew Simpson , Andrew McDonald , Thomas Zilli
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引用次数: 0

摘要

淋巴结阳性前列腺癌(N1 PCa)的治疗仍然是一个持续争论的主题,越来越多的证据支持放射治疗(RT)与全身治疗的作用。传统上,N1疾病被认为是转移性的;然而,成像和治疗的进步重新定义了其临床意义。这篇叙述性综述评估了目前的证据,重点关注最近的文献和正在进行的N1 PCa临床试验,包括确诊和术后情况。前列腺特异性膜抗原(PSMA)正电子发射断层扫描-计算机断层扫描(PET/CT)显著提高了分期准确性,导致cN1疾病患者的分期迁移和RT的考虑增加。回顾性和前瞻性研究均表明,与单独ADT相比,RT联合雄激素剥夺治疗(ADT)可提高生存率。来自大型临床试验和正在进行的研究的可靠数据支持使用全盆腔放疗(WPRT),剂量逐渐增加到受累淋巴结。术后pN1疾病的最佳管理仍然存在争议,策略从观察到早期抢救或辅助RT,通常与全身治疗相结合。理想的RT体积、剂量和全身治疗组合仍在研究中。然而,一些正在进行的试验正在为更精细和有效的治疗方法铺平道路。这篇综述强调了在不久的将来可能显著改善N1型前列腺癌管理的关键试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Radiation Therapy in Node-Positive Prostate Cancer: Current Evidence and Future Directions
The management of node-positive prostate cancer (N1 PCa) remains a subject of ongoing debate, with growing evidence supporting the role of radiation therapy (RT) alongside systemic therapy. Traditionally, N1 disease was considered metastatic; however, advancements in imaging and treatment have redefined its clinical relevance. This narrative review evaluates current evidence, focusing on recent literature and ongoing clinical trials in N1 PCa, both in the definitive and postoperative setting. Prostate-specific membrane antigen (PSMA) positron emission tomography-computed tomography (PET/CT) has significantly improved staging accuracy, leading to stage migration and increased consideration of RT for patients with cN1 disease. Both retrospective and prospective studies suggest that RT combined with androgen deprivation therapy (ADT) improves survival compared to ADT alone. Robust data from large clinical trials and ongoing studies support the use of whole-pelvic RT (WPRT) with dose escalation to involved nodes. The optimal management of postoperative pN1 disease remains controversial, with strategies ranging from observation to early salvage or adjuvant RT, often combined with systemic therapy. The ideal RT volume, dose, and systemic therapy combinations continue to be investigated. However, several ongoing trials are paving the way for more refined and effective treatment approaches. This review highlights key trials that may significantly improve the management of N1 PCa in the near future.
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来源期刊
CiteScore
5.80
自引率
0.00%
发文量
48
审稿时长
>12 weeks
期刊介绍: Each issue of Seminars in Radiation Oncology is compiled by a guest editor to address a specific topic in the specialty, presenting definitive information on areas of rapid change and development. A significant number of articles report new scientific information. Topics covered include tumor biology, diagnosis, medical and surgical management of the patient, and new technologies.
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