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Using Fiducial Markers to Aid in Prostate Cancer Radiation Treatment

This study has been completed.
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) ) Identifier:
First received: May 23, 2003
Last updated: June 30, 2017
Last verified: May 23, 2017

To effectively treat prostate cancer, doctors need an accurate view (via X-rays) of the prostate gland during radiation therapy. To help improve this view, doctors may insert gold markers called fiducials into the prostate by placing hollow gold needles through the rectum and moving a fiducial through each needle. The purpose of the study is to determine whether an MRI scan can help doctors improve their placement of these needles.

Fifteen men will participate in this study. Patients will take the antibiotic levofloxacin for two days prior to the placement of the fiducials, then will have a small enema and another dose of the antibiotic on the morning of the procedure. After being anesthetized, patients will have an antenna-like tube placed into the rectum and have MRI images taken of the area. The doctor will then use these scans to place four fiducials into the prostate. The procedure will require approximately 45 minutes. Patients will be allowed to go home the same day of the procedure, which will be followed by a seven-week course of standard radiation therapy.

Prior to their participation in this study, patients will undergo the following evaluations: a physical exam, blood work, urine tests, and, if appropriate, an MRI or bone scan.

Condition Intervention Phase
Prostate Cancer Cancer Procedure: Fiducial marker placement Phase 1

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Trans-Rectal Placement of Prostatic Fiducial Markers Under MR-Guidance in Patients Receiving External Beam Radiotherapy for Prostate Cancer: A Pilot Study

Resource links provided by NLM:

Further study details as provided by National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) ):

Primary Outcome Measures:
  • To test the hypothesis that MRI guidance allows for accurate fiducial marker placement within the prostate [ Time Frame: 1, 3, 6, 12, 18, 24, 36, 48, and 60 months ]
  • To determine the toxicity of MR-Guided fiducial marker placement [ Time Frame: 1, 3, 6, 12, 18, 24, 36, 48, and 60 months ]

Secondary Outcome Measures:
  • To gain preliminary experience using intraprostatic fiducial markers for daily set-up assessment and adjustment of external radiation beam targeting. [ Time Frame: completion of study ]
  • To gain preliminary experience using intraprostatic fiducial markers for image fusion. [ Time Frame: completion of study ]
  • To measure the magnitude of marker migration during the course of radiotherapy. [ Time Frame: completion of study ]
  • To gather data on radiation therapy effects on prostate cancer patients treated at the NCI ROB. [ Time Frame: completion of study ]
  • To gather data on the feasibility, tolerability, and effectiveness of local anesthetic injection along the neurovascular bundle under MRI guidance. [ Time Frame: completion of study ]

Enrollment: 15
Study Start Date: May 21, 2003
Study Completion Date: April 4, 2011
Primary Completion Date: May 31, 2004 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
Placement of fidicual markers under MRI guidance for localization of radiaiton treatment
Procedure: Fiducial marker placement
Placement of fidicual markers under MRI guidance for localization of radiaiton treatment

Detailed Description:

Effective image-guided prostate therapies require excellent visualization of the prostate and surrounding anatomy, such that cancerous tissue can be treated while avoiding nearby neural and vascular structures. As such, Magnetic Resonance Imaging is well suited for image-guidance because of its excellent soft tissue contrast, multiplanar capabilities, and the potential to yield spectral/biological tumor mapping. Despite the potential for MRI-guided prostate therapies, there are currently no techniques that allow for precise trans-rectal intraprostatic needle placement in patients.

In this pilot study we seek to validate the accuracy and tolerability of a new system and technique that allows for accurate placement of needles within the prostate based upon MR images. The method is very similar to transrectal ultrasound guided biopsy of the prostate, except that it is applicable within a closed high-field MRI scanner. Four gold fiducial markers will be placed within the prostate under needle guidance in a series of patients with localized prostate cancer before external beam radiotherapy. Fifteen patients will be enrolled onto this study with sample size determined to obtain reasonably precise estimates of mean placement accuracy. The accrual period is expected to be less than a year.

While placement of the fiducial markers has no direct therapeutic benefit for the patient, intraprostatic radiopaque fiducial markers (placed under ultrasound) have shown value in assessing daily setup errors and off-line organ motion during external beam radiation therapy for prostate cancer. Therefore, a secondary objective is to gain experience using these intraprostatic fiducial markers for daily assessment and adjustment of external radiation beam targeting. These markers can also be utilized to aid in CT-MRI fusion and results in better target delineation for treatment planning. In this way, prostate cancer patients who are receiving external-beam radiation therapy may benefit from participation.


Ages Eligible for Study:   18 Years to 90 Years   (Adult, Senior)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
  • Pathologically confirmed adenocarcinoma of the prostate gland.
  • Age greater than or equal to 18 years.
  • ECOG performance status of 0 or 1.
  • Informed consent: All patients must sign a document of informed consent indicating their understanding of the investigational nature and risks of the study before any protocol related studies are performed (this does not include routine laboratory tests or imaging studies required to establish eligibility).


Patients with contraindication to transrectal needle placement:

  • Bleeding disorder;
  • PT/PTT greater than 1.5.times the upper limit of normal;
  • Platelets less than 50K;
  • Artificial heart valve.

Patients with contraindications to MRI:

  • Patients weighing greater than 136 kg (weight limit for scanner table);
  • Patients with pacemakers, cerebral aneurysm clips, shrapnel injury, or implanted electronic devices.
  • Patients with chronic inflammatory bowel disease.
  • Patients with distant metastatic disease.
  • Patients with a prior history of pelvic or prostate radiotherapy.
  • Cognitively impaired patients who cannot give informed consent.
  • Other medical conditions deemed by the PI or associates to make the patient ineligible for protocol investigations, procedures, and high-dose external beam radiotherapy.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT00061347

United States, Maryland
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
National Cancer Institute (NCI)
Principal Investigator: Kevin A Camphausen, M.D. National Cancer Institute (NCI)
  More Information

Additional Information:
Responsible Party: National Cancer Institute (NCI) Identifier: NCT00061347     History of Changes
Obsolete Identifiers: NCT00882349
Other Study ID Numbers: 030190
Study First Received: May 23, 2003
Last Updated: June 30, 2017

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) ):
Fiducial Marker
Prostate Cancer

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Genital Diseases, Male
Prostatic Diseases processed this record on September 21, 2017