Table 3 PET changes in nodal stage by T stage and impact of changes on management
CIm nodal stage | PET nodal stage | Impact | RT field changes due to PET |
|---|---|---|---|
Primary tumour stage | |||
T1 | |||
N0 | N3 (ili) | None | Radiation fields planned as for stage 1 disease. (i.e. 2 phase posterior pelvis with no prophylactic inguinal node RT) |
N0 | N2 (R ili) | None | |
N3 (bil ili) | N0 | Medium | Phase 3 boost to primary only |
T2 | |||
N0 | N2 (ili) | None | Phase 1 and 2 fields upper border not changed. Phase 3 boost to primary only |
N3 (ing+ili) | N3M1 (PAN) | None | Patient treated with radical intent (PAN not treated). Subsequently progressed in PAN |
N1 | N0 | None | Peri-rectal nodes remote from primary. No phase 3 boost field size reduction from phase 2 |
N0 | N1 | Low | Proximity of peri-rectal nodes to primary meant included in phase 3 boost to primary without requiring change in field size |
N1 | N0 | Low | |
N2 (R ing) | N3 (ing+p-r) | Low | |
N3 (ing+p-r) | N2 (R ing) | Low | |
N0 | N3 (R ili+p-r) | Medium | Superior border increased phase 1 and 2 fields. R ili node covered in phase 3 boost |
N2 (R ing) | N0 | Medium | No phase 1 field change or phase 2/3 electron boost to R groin |
N3 (bil ing) | N2 (R ing) | Medium | No phase 1 field change or phase 2/3 electron boost to L groin |
T3/4 | |||
N0a | N2 (L ili) | Medium | Superior border phase 1 and 2 fields increased to cover iliac nodes. L ili covered in phase 3 boost |
N3 (bil ing) | N2 (R ing) | Medium | No phase 1 field change or phase 2/3 electron boost to L groin |
N0 | N2 (L ing) | Medium | Phase 1 field change and phase 2/3 electron boost L groin |
N3 (L ing p-r) | N3 (bil ing/ili) | Medium | Phase 1 and 2 field changes. Phase 2/3 electron boost to bilateral groins |
N3M1 (ing +PAN) | N1M0 | High | Intent changed from palliative to radical |
N3M0 (p-r,ing +ili) | N3M1 (PAN) | High | Intent and dose changed from radical to palliative |
