A retrospective analysis of the prognosis of prostate cancer patients with lymph node involvement on MR lymphography: who might be cured

Meijer, Hanneke; Debats, Oscar A.; Lin, Emile N.J.T. van; Witjes, J. Alfred; Kaanders, J.H.A.M.; Barentsz, Jelle O.

doi:10.1186/1748-717x-8-190

Cited by 12 publications

(7 citation statements)

References 20 publications

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“…With CEM as a technique to (re)define oligometastatic disease, these therapies might even be given with curative intent. 4,5,51,52 Furthermore, knowledge on size of lymph node metastases can help predict prognosis. Patients with nodal metastases ≤8 mm versus larger nodal metastases have a significantly better 5-year metastasis-free survival (79% vs 16%) and overall survival (81% vs 36%).…”

Section: Uspio-enhanced Mri: Earlier Results Of Combidexmentioning

confidence: 99%

“…Detecting small lymph node metastases or detecting limited metastatic disease provides opportunities for more patient‐tailored therapy. With CEM as a technique to (re)define oligometastatic disease, these therapies might even be given with curative intent …”

Section: Uspio‐enhanced Mri: Earlier Results Of Combidexmentioning

confidence: 99%

“…This results not only in an underestimation of lymph node involvement but also in a false‐negative diagnosis for the patient . A follow‐up study suggested a clinical benefit of removing as many metastatic lymph nodes as possible in comparison with subtotal removal, as was shown in a better 5‐year survival of 80% versus 35%, respectively . In a recent systematic review, however, a direct therapeutic effect was not evident, and more e‐PLNDs were associated with worse intraoperative and perioperative outcomes .…”

Section: Introductionmentioning

confidence: 99%

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Ultra‐small superparamagnetic iron oxides for metastatic lymph node detection: back on the block

Fortuin

Brüggemann

Linden

et al. 2017

WIREs Nanomed Nanobiotechnol

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In the past 15 years, encouraging clinical results for the detection of small lymph node metastases was obtained by the use of Combidex‐enhanced MRI (CEM, also known as magnetic resonance lymphography). Withdrawal of the European Medicines Agency approval application by the manufacturer made it impossible for patients to benefit from this agent; a loss, especially for men with prostate cancer. Current conventional imaging techniques are not as accurate as CEM is, thus a surgical diagnostic exploration (extended lymph node dissection) is still the preferred technique to evaluate the lymph nodes, resulting in peri‐ and postoperative complications. In 2013, the Radboud University Medical Center (Radboudumc) obtained all licenses and documentation for the production process of Combidex (ferumoxtran‐10), and manufactured the contrast agent under supervision of the Department of Pharmacy. Since 2014, 310 men with prostate cancer have been examined with CEM in the Radboudumc. Within this cohort, seven minor possibly contrast‐related adverse effects were observed after administration of Combidex. As the contrast agent is now back again in the Netherlands, this review highlights the working mechanism, previous results, observed side effects since the reintroduction, and the future perspectives for Combidex. WIREs Nanomed Nanobiotechnol 2018, 10:e1471. doi: 10.1002/wnan.1471This article is categorized under: Diagnostic Tools > In Vivo Nanodiagnostics and ImagingTherapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease

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Section: Uspio-enhanced Mri: Earlier Results Of Combidexmentioning

confidence: 99%

Section: Uspio‐enhanced Mri: Earlier Results Of Combidexmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Ultra‐small superparamagnetic iron oxides for metastatic lymph node detection: back on the block

Fortuin

Brüggemann

Linden

et al. 2017

WIREs Nanomed Nanobiotechnol

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“…Meijer et al[ 31 ] showed a better prognosis in a subset of patients with MRL positive lymph nodes that were < 8 mm and better outcomes in patients in whom all MRL positive lymph nodes were resected. This highlights a window of opportunity for cure in these patients as those with MRL-detected positive nodes that were entirely removed had a five-year distant metastatic disease free survival of 80% compared to 35% in the patients who did not have all MRL-detected positive nodes removed[ 31 ].…”

Section: Lymph Node Imaging With Mrimentioning

confidence: 99%

Lymph node imaging in initial staging of prostate cancer: An overview and update

Zarzour

Galgano

McConathy

et al. 2017

WJR

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Accurate nodal staging at the time of diagnosis of prostate cancer is crucial in determining a treatment plan for the patient. Pelvic lymph node dissection is the most reliable method, but is less than perfect and has increased morbidity. Cross sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) are non-invasive tools that rely on morphologic characteristics such as shape and size of the lymph nodes. However, lymph nodes harboring metastatic disease may be normal sized and non-metastatic lymph nodes may be enlarged due to reactive hyperplasia. The optimal strategy for preoperative staging remains a topic of ongoing research. Advanced imaging techniques to assess lymph nodes in the setting of prostate cancer utilizing novel MRI contrast agents as well as positron emission tomography (PET) tracers have been developed and continue to be studied. Magnetic resonance lymphography utilizing ultra-small super paramagnetic iron oxide has shown promising results in detection of metastatic lymph nodes. Combining MRL with diffusion-weighted imaging may also improve accuracy. Considerable efforts are being made to develop effective PET radiotracers that are performed using hybrid-imaging systems that combine PET with CT or MRI. PET tracers that will be reviewed in this article include [18F]fluoro-D-glucose, sodium [18F]fluoride, [18F]choline, [11C]choline, prostate specific membrane antigen binding ligands, [11C]acetate, [18F]fluciclovine, gastrin releasing peptide receptor ligands, and androgen binding receptors. This article will review these advanced imaging modalities and ability to detect prostate cancer metastasis to lymph nodes. While more research is needed, these novel techniques to image lymph nodes in the setting of prostate cancer show a promising future in improving initial lymph node staging.

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“…Many radiological and less invasive methods (including sentinel node biopsy) are described to determine lymph node involvement in prostate cancer. [ 6 7 ] However, till date, pelvic lymph node dissection is the only reliable and effective method to ascertain the presence of lymph node metastases in patients undergoing radical prostatectomy. Various nomograms, based on pre-operative parameters, have been described to predict the probability of lymph node positivity.…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for lymph node positivity in patients undergoing extended pelvic lymphadenectomy during robot assisted radical prostatectomy

et al. 2015

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Introduction:Pelvic lymphadenectomy during radical prostatectomy (RP) improves staging and may provide a therapeutic benefit. However, there is no clear consensus on the selection criteria for subjecting patients to this additional procedure. With a growing adoption of robot assisted radical prostatectomy (RARP) in India, it has become imperative to study the incidence and predictive factors for lymph node involvement in our patients.Materials and Methods:From February 2010 to February 2014, 452 RARP procedures were performed at our institution. A total of 100 consecutive patients from July 2011 to August 2012 were additionally subjected to a robotic extended pelvic lymphadenectomy (EPLND). Lymph node positivity rates and lymph node density were analyzed on the basis of preoperative prostate specific antigen (PSA), Gleason score, clinical stage, D’Amico risk category and magnetic resonance imaging (MRI) findings. Multivariate analysis was performed to ascertain factors associated with lymph node positivity in our cohort.Results:The mean age of the patients was 65.5 (47–77) years and the body mass index was 26.3 (16.3–38.7) kg/m2. The mean console time for EPLND was 45 (32–68) min. A median of 17 (two to 40) lymph nodes were retrieved. Seventeen patients (17%) had positive lymph nodes (median of 1, range 1–6). Median lymph node density in these patients was 10%. When stratified by PSA, Gleason score, clinical stage, D’Amico risk category and features of locally advanced disease on MRI, a trend towards increasing incidence of lymph node positivity was observed, with an increase in adverse factors. However, on multivariate analysis, clinical stage > T2a was the only significant factor impacting lymph node positivity in our cohort.Conclusions:A significant proportion of men undergoing RARP in India have positive lymph nodes on EPLND. While other variables may also have a potential impact, a higher clinical stage predisposes to an increased incidence of lymph node metastases.

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A retrospective analysis of the prognosis of prostate cancer patients with lymph node involvement on MR lymphography: who might be cured

Cited by 12 publications

References 20 publications

Ultra‐small superparamagnetic iron oxides for metastatic lymph node detection: back on the block

Ultra‐small superparamagnetic iron oxides for metastatic lymph node detection: back on the block

Lymph node imaging in initial staging of prostate cancer: An overview and update

Predictive factors for lymph node positivity in patients undergoing extended pelvic lymphadenectomy during robot assisted radical prostatectomy

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