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A big reason for treatment failures after whole pelvic radiation or ePLND

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Prostate Cancer
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Posted 2/4/2017 12:19 AM (GMT -5)
The treatment area isn't wide enough. The problem is that the risk of SEs go up as the treatment area gets bigger.But if you are having surgery with pelvic lymph node dissection (PLND) or whole pelvic radiation as part of first-line therapy or salvage, this is a good topic to discuss with your urologist or RO.

Pelvic lymph node treatment area is seldom wide enough
Posted 2/4/2017 1:10 PM (GMT -5)
Interesting. I was one of the ones who started with radiation of the pelvic lymph nodes but stopped almost immediately with small bowel damage. That concerned me so that helped me make the decision for the chemo boost. Time will tell how it all worked. Thanks Allen. -JR
Posted 2/4/2017 3:27 PM (GMT -5)
I had pelvic lymph node irradiation to 50.4 Gy. I have a picture of the treatment fields, but have no idea if it covered those iliac lymph nodes or not. From what I can find online, it doesn't look like it did.

Luckily, I had no side effects from the nodes being treated. No bowel issues or anything.
Posted 2/4/2017 3:33 PM (GMT -5)
The reference from University Hospital Munich has a couple of good illustrations.
Posted 2/4/2017 4:05 PM (GMT -5)
Allen - you write about ePLND as it was primarily for treatment. What I was told by my surgeon was that the ePLND was primarily for staging and secondary for treatment. If cancer would have spread to the LNs he would need luck if he would get all the affected nodes. The study you refer to support this statement I think, or ..? Accurate for staging but rather bad as treatment.
Posted 2/4/2017 4:48 PM (GMT 0)
Gemlin -

It is for both staging and improving survival. But whether it does in fact improve survival is controversial, as you can see in the conflicting data in the following two studies:

More Extensive Pelvic Lymph Node Dissection Improves Survival in Patients with Node-positive Prostate Cancer

Is extended pelvic lymph node dissection for prostate cancer the only recommended option? A systematic overview of the literature

Because there are risks of lymphocele and lymphedema, its use remains controversial. It would be a very radical procedure to undertake if its only use were for staging.

NCCN Guidelines said...
Pelvic Lymph Node Dissection:

• An extended PLND will discover metastases approximately twice as often as a limited PLND. Extended PLND provides more complete staging and may cure some men with microscopic metastases; therefore, an extended PLND is preferred when PLND is performed.

• An extended PLND includes removal of all node-bearing tissue from an area bound by the external iliac vein anteriorly, the pelvic sidewall laterally, the bladder wall medially, the floor of the pelvis posteriorly, Cooper's ligament distally, and the internal iliac artery proximally.

• A PLND can be excluded in patients with <2% predicted probability of nodal metastases by nomograms, although some patients with lymph node metastases will be missed.

• PLND can be performed using an open, laparoscopic, or robotic technique.

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