Within the oligometastatic state, oligorecurrent lymph node disease in prostate cancer represents an interesting clinical entity characterized by a relatively indolent biology that makes it unique: it can be treated radically, and its treatment is usually associated with a long period of control and excellent survival. Additionally, it is an emergent situation that we are facing more frequently mainly due to (a) the incorporation into clinical practice of the PSMA-PET that provides strikingly increased superior images in comparison to conventional imaging, with higher sensitivity and specificity; (b) the higher detection rates of bone and node disease with extremely low levels of PSA; and (c) the availability of high-precision technology in radiotherapy treatments with the incorporation of stereotaxic body radiotherapy (SBRT) or stereotaxic ablative radiotherapy (SABR) technology that allows the safe administration of high doses of radiation in a very limited number of fractions with low toxicity and excellent tolerance. This approach of new image-guided patient management is compelling for doctors and patients since it can potentially contribute to improving the clinical outcome. In this work, we discuss the available evidence, areas of debate, and potential future directions concerning the utilization of new imaging-guided SBRT for the treatment of nodal recurrence in prostate cancer.
在前列腺癌的寡转移状态中，寡复发淋巴结疾病是一个值得关注的临床实体，其特点是相对惰性的生物学特性，使其具有独特性：可以进行根治性治疗，且治疗后通常能获得长期控制及良好的生存期。此外，这种情况正日益常见，主要原因包括：（a）PSMA-PET在临床实践中的应用，与传统影像学相比，其提供的图像质量显著提高，具有更高的敏感性和特异性；（b）在极低PSA水平下对骨和淋巴结疾病的检出率提高；（c）放射治疗中高精度技术的应用，特别是立体定向体部放疗（SBRT）或立体定向消融放疗（SABR）技术的引入，使得在极少数分次中安全实施高剂量照射成为可能，且毒性低、耐受性良好。这种基于新影像技术的患者管理模式对医生和患者具有吸引力，因为它有望改善临床结局。本文讨论了关于利用新型影像引导SBRT治疗前列腺癌淋巴结复发的现有证据、争议领域以及未来可能的发展方向。
肿瘤(癌症)患者之家