Prostatic Neoplasms
Conditions
Brief summary
Delivery of conformal radiation therapy following radical prostatectomy is limited by the inability to define the clinical target volume (CTV). This stems from a poor understanding of patterns of local recurrence and limitations of standard imaging techniques.Magnetic Resonance Imaging (MRI) is a promising modality for imaging the prostatic bed following radical prostatectomy. MRI provides more detailed postoperative anatomy to guide CTV delineation, the ability to document local recurrence patterns, and a method to assess intrafraction prostatic bed motion and deformity to define appropriate planning target volume margins. The aim of this pilot study is to develop a technique for external beam radiation therapy (EBRT) following radical prostatectomy based on MRI-delineation of the CTV. Twenty patients will be enrolled in this pilot, development phase.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
* Patients following radical prostatectomy for prostate adenocarcinoma with one or more of the following adverse features: pT2 + positive surgical margins ) pT3 ) PSA ≤ 2ng/ml Persistently elevated PSA at 3 months ) * Patients with initially undetectable PSA following prostatectomy for prostate adenocarcinoma with subsequent PSA relapse * Patients being planned for radiation therapy * No evidence of distant metastases * Age ≥ 18 years * ECOG performance status 0 or 1 * Informed consent
Exclusion criteria
* Contraindications to MRI Patients weighing \>136 kgs (weight limit for the scanner tables) Patients with pacemakers, cerebral aneurysm clips, shrapnel injury or implantable electronic devices not compatible with MRI. * Severe claustrophobia * Inflammatory bowel disease or collagen vascular disease * Previous colorectal surgery * Previous pelvic radiotherapy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| To develop a technique for MRI-delineation of the clinical target volume (CTV) for EBRT following radical prostatectomy | After data acquisition |
Secondary
| Measure | Time frame |
|---|---|
| To compare the location of the urethral anastomosis defined on MRI as compared to a fiducial marker placed under TRUS-guidance adjacent to the anastomosis. | After data acquisition |
| To measure the amount of intrafraction movement and deformity of the prostatic bed and seminal vesicles with current bowel regimen of daily milk of magnesia using cinematic MRI. | After data acquisition |
| To compare the reproducibility of clinical target volume and rectal wall volume delineation on MRI and CT. | After data acquisition |
| To measure the amount of interfraction movement and deformity of the bladder, rectum, and surgical clips within the operative bed using daily cone-beam CT imaging. | After data acquisition |
| To explore the utility of IV contrast for the delineation of gross tumor recurrence and normal blood vessels. | After data acquisition |
| To determine the optimal radiation technique that encompasses the MRI-defined PTV whilst respecting bowel and bladder dose constraints. | After data acquisition |
Countries
Canada