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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.
To develop a technique for MRI-delineation of the clinical target volume (CTV) for EBRT following radical prostatectomy [ Time Frame: After data acquisition ]
Secondary Outcome Measures
To compare the reproducibility of clinical target volume and rectal wall volume delineation on MRI and CT. [ Time Frame: After data acquisition ]
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. [ Time Frame: 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. [ Time Frame: After data acquisition ]
To determine the optimal radiation technique that encompasses the MRI-defined PTV whilst respecting bowel and bladder dose constraints. [ Time Frame: 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. [ Time Frame: After data acquisition ]
To explore the utility of IV contrast for the delineation of gross tumor recurrence and normal blood vessels. [ Time Frame: After data acquisition ]
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Ages Eligible for Study:
18 Years and older (Adult, Senior)
Sexes Eligible for Study:
Accepts Healthy Volunteers:
Patients following radical prostatectomy for prostate adenocarcinoma with one or more of the following adverse features:
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
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.
Inflammatory bowel disease or collagen vascular disease