More evidence for salvage whole pelvic radiation after positive lymph nodes have been detected

[Tall_Allen]

Updated this with the first randomized trial data:

prostatecancer.news/2017/12...

[cesces]

Are there any studies evaluating the option of laproscopic removal of cancerous pelvic lymph nodes prior escalating to bathing the entire pelvis with radiation?

[Tall_Allen in reply to cesces]

I guess you didn't read the article.

[cesces in reply to Tall_Allen]

I tried. I'll try again.

Not so easy on a phone.

[cesces in reply to cesces]

I went back and I still don't see it. Though admittedly your writing can sometimes be a bit heavy for me to digest.

So I did searches on "surg" and "ectomy".

Certainly nothing about lymphectomies, endoscopic or otherwise.

Unless you are confusing biopsies and/or prostatectomies for endoscopic lymphectomies.

????

Can someone else read the article and point out what I may be missing?

[Tall_Allen in reply to cesces]

The very first bullet point:

• All patients had 1-4 positive PLNs found via PLND, most had 1 positive PLN

PLND is defined in the first paragraph:

Is it still worthwhile to attempt salvage radiation (SRT) after positive pelvic lymph nodes (PLN) have been pathologically detected (stage pN1)? Traditionally, patients with PLN dissection (PLND)-diagnosed pN1 prostate cancer have been considered to have incurable systemic disease.

[cesces in reply to Tall_Allen]

"A pelvic lymph node dissection (PLND) is surgery to remove the lymph nodes from the. pelvis."

hystersisters.com/vb2/artic...

Ahhh, got it. Thanks

[m1946 in reply to Tall_Allen]

I have been recommended to have a 'Sabre' treatment with a MR Linac machine which is capable of targeting a tumor on a lymph node in the pelvic region and 'zapping'it

The tumor was diagnosed after a petscan . The cancer was very close to the uter hence the reason for the use of an upgraded MR Linac machine!! (UK)

[Tall_Allen in reply to m1946]

It is OK to give a boost dose to the single lymph node, but it is not OK to only treat that single lymph node. Where there is one that can be seen on a PET scan, there are many more that are too small to be seen in the pelvic lymph node region.

prostatecancer.news/2020/12...

The same MR Linac can be used to treat the entire pelvic lymph node area. You will also require 2 years of hormone therapy (ADT+Zytiga).

[m1946 in reply to Tall_Allen]

Thank you

Being 76 I understand that with age there is a possibility that tumors do not grow as fast as if I was a younger man

[Tall_Allen in reply to m1946]

Or they may grow faster, which is usually the case.

[GMorz]

great update Thank you

[chickgreen]

Thank you. I actually start IMRT this coming week, and this is further evidence to help me feel better about everything

[MSPCF2021]

Thank you TA. I am interested in hearing from those who have had this ⬆️ particular treatment (whole pelvis, salvage— what’s mentioned in this linked article in TA’s post) about the acute and late urinary, bowel, and sexual toxicity you’ve experienced. And, what kind of scans and planning were done with your RO to minimize any of these toxicities. There is some writing about MRI and other imaging to avoid damage caused by uncontrollable movement (eg intestines) during treatment.

[Vangogh1961]

As many people as I have seen that have had RP and then had progression year(s) later I would think this should be SOC.