Prophylactic Treatment of the Pelvic Lymphatics: Contra

According to the opinion of the author, to date—applying evidence-based medicine—physicians should not perform prophylactic pelvic lymph node irradiation in routine practice for locally advanced prostate cancer because of the lack of any demonstrated benefit. In addition, this treatment has a higher risk of acute and late toxicities. Standard prognostic factors and nomograms, failed to identify a subgroup of patients who may benefit from pelvic lymph nodes irradiation. Several biases including technical radiotherapy features (target volume, dose) are discussed. Radiation oncologistsshould be encouraged to participate in the ongoing RTOG 094 international randomized study.