Prostate CancerPhase 2NCT00039624
Magnetic Resonance-Guided High-Dose Brachytherapy (Short-Range Radiation Therapy) for Prostate Cancer
A Phase 2 study testing Brachytherapy in people with Prostate Cancer, run by National Cancer Institute (NCI) at 1 site in United States.
Trial summary
This study will evaluate the use of magnetic resonance imaging (MRI) for guiding placement of hollow needles into the prostate gland for delivering internal radiation therapy to patients with prostate cancer. Read more about this study
- Who is it for?
- Ages 18 to 90 years, men only
- Conditions the study is for
- Prostate Cancer
- What is being tested?
- Brachytherapy
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 12 participants
- Where
- 1 siteUnited States
- Study dates
- 3 Jun 2002to 31 Jul 2018
- Phase
- Phase 2
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 90 years
- Men only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Pathologically confirmed prostate cancer with the following features: Gleason score greater than 6, or greater than T2a, or PSA greater than or equal to 10, and no evidence of bone metastases
- 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).
Who cannot join
- History of prior pelvic or prostate radiotherapy
- TURP within the last 6 months or large TURP defect
- Contraindication to implant procedure:
- Bleeding disorder
- Active anticoagulation at the time of implant
- Artificial heart valve
Show all 15Show fewer
- Contraindication to MRI:
- Patients weighing greater than 136 kgs (weight limit for the scanner tables)
- Patients with pacemakers, cerebral aneurysm clips, shrapnel injury or implantable electronic devices.
- Preexisting significant urinary obstructive symptoms as reflected by a high (greater than 18) International Prostate Symptom Score (IPSS)
- Pubic arch interference or inadequate access to perineum as determined by preliminary MRI
- Cognitively impaired patients who cannot give informed consent
- Medically Unfit for Anesthesia as defined by an anesthesiology consultant
- Other active malignancy (except for non-melanoma skin cancer or malignancy which was treated with curative intent at least 3 years ago with no further evidence of recurrent disease.)
- Other urinary or medical conditions deemed by the PI or associates to make the patient ineligible for high dose rate brachytherapy and EBRT.
Trial locations and contacts
1 site in 1 country.
United States1 site
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, Maryland, 20892
About this study
Official title: A Phase II Study of MR-Guided High Dose Rate Brachytherapy Boosts For Prostate Cancer
This study will evaluate the use of magnetic resonance imaging (MRI) for guiding placement of hollow needles into the prostate gland for delivering internal radiation therapy to patients with prostate cancer. Prostate cancer is often treated with a combination of external beam radiation therapy and brachytherapy (internal radiation delivered close to the tumor). This study will determine whether MRI is more accurate in guiding needle placement than ultrasound, which is currently used for this purpose. Patients will have one brachytherapy treatment followed by 5 weeks of external beam treatments and a second brachytherapy.
Patients 18 years of age and older with prostate cancer that has not spread to the bone may be eligible for this study. Candidates will be screened with a physical examination, blood and urine tests, and a bone scan.
Read more
To plan for radiation therapy, patients will have standard computed tomography (CT) and MRI scans of the pelvis and prostate. In addition, CT and MRI scans will be done to determine if the prostate is in a good position for brachytherapy. For these scans, patients will have an enema and a tube will be placed in the rectum. They will then lie still on their side for about 45 minutes during the scan. Patients who have blood in their urine will also undergo cystoscopy. This is an examination of the bladder using a small camera that is advanced through the penis into the bladder.
Patients are given an antibiotic for 2 days before the brachytherapy and on the morning of the procedure. Before the test, they have a small enema and are given medicines through the vein and into the spine for relaxation and to decrease any discomfort. (The test is done under general anesthesia for patients who require it.) The patient is moved on a stretcher into the MRI scanner and a catheter is inserted into the bladder through the penis. The bladder is filled with water and a tube is placed in the rectum. With the help of a plastic guide placed against the skin, about 14 to 18 needles are then placed in the prostate. Some stitches are sewn to hold the needles and the guide in place, and the tube in the rectum is removed. The patient is the transferred from the MR scanner into the CT scanner, where the rectal tube is reinserted and the needles are adjusted. A cystoscopy is done to make sure the needles do not enter the bladder. When the needles are adjusted, the tube is removed from the rectum and the patient is moved to the radiation oncology clinic.
After a few hours, when the radiation dose has been calculated, a radioactive substance called iridium is administered. The needles placed in the prostate are connected to a radiation machine, and thin wires with radioactive material on the tips are inserted into each needle and withdrawn a little at a time. The process takes about 20 to 30 minutes. The patient is then disconnected from the machine and undergoes another MRI scan to confirm the position of the needles. The needles and catheter are then removed and the patient is monitored for a while before going home. Patients then have 5 weeks of external beam therapy, followed by a second brachytherapy treatment.
Patients return to the clinic at 1, 3, 6, 12, 18, 24, 36, 48, and 60 months after treatment for blood tests, physical examination, and review of symptoms.
Read the detailed description
BACKGROUND
Brachytherapy, the placement of a radioactive source close to a tumor, is rapidly becoming an important modality for patients with prostate cancer because higher and more conformal doses can be safely delivered compared with external beam radiotherapy.
High dose rate (HDR) temporary implants offer several treatment and research based advantages over permanent seeds, including exceptionally complex and accurate dosimetry in reference to anatomic images.
Needle placement in brachytherapy procedures requires detailed image guidance, traditionally obtained with trans-rectal ultrasound (TRUS). MRI offers a 3D dataset, arbitrary imaging planes, and unparalleled soft tissue resolution of the anatomy, making it the modality of choice for imaging the prostate gland.
A real-time MR-guided prostate permanent seed implant technique that utilizes both real-time MRI and real-time dosimetry has been designed, implemented and reported. Results confirm that TRUS-guided implants may be improved upon by using MRI. To our knowledge, HDR implants have not yet been performed under MR guidance in a closed bore magnet.
OBJECTIVES
The primary objective is to determine the quality of prostate HDR brachytherapy implants performed under MR-guidance.
Quality is defined by the percentage of the planning target volume (PTV) encompassed by a given percentage of the prescribed dose. In this study an implant will be of "acceptable" quality if 80% of the PTV is encompassed by the 100% isodose (V100 80%), in accordance with RTOG guidelines.
ELIGIBILITY
Pathologically confirmed prostate cancer with the following features:
- Gleason score greater than 6, or greater than T2a, or
- PSA greater than or equal to 10, and no evidence of bone metastases;
Age greater than or equal to 18 years;
ECOG performance status of 0 or 1
DESIGN
The study is designed with a "run-in" pilot phase with the objective of refining the technique.
The evaluation phase is a two-stage optimal design to evaluate the quality of the implant with an early look for futility.
This study has the potential to enroll a maximum of 27 patients.
Radiation treatment parameters will be patterned after established guidelines in the literature such as those reported by the American Brachytherapy Society and the William-Beaumont Hospital. There will be no attempted dose escalation or attempts to prescribe the dose to unconventional target volumes in this phase of the project.
- Conditions
- Prostate Cancer
- Being tested
- Brachytherapy
- Keywords
- Radiation Therapy, Prostate, MRI, Brachytherapy, Phase II, Prostate Cancer
- Medical subject headings
- Prostatic Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
BrachytherapyRadiation
Patients will receive two HDR brachytherapy implants (950-1050 cGy/implant) before and at the end of a course of external beam radiotherapy (4600 cGy, 2Gy/day).
| Study group | Role | What they receive |
|---|---|---|
| Brachy | Experimental | brachytherapy Receives: Radiation: Brachytherapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
To evaluate the quality of brachytherapy implants performed under MR-guidance.
Measured: 60 months
Secondary outcomes (3)
To document patient tolerance and treatment toxicities associated with our EBRT + MR-Guided brachytherapy boost technique.
Measured: 60 months
To measure the magnitude of spatial distortion in MR images and it's impact on dosimetric accuracy
Measured: 60 months
To document time to biochemical failure and survival distributions in this group of patients.
Measured: 60 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Jun 2002 (estimated)
- Study start3 Jun 2002
- Primary completion29 Jul 2004
- Study completion31 Jul 2018
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Prostate CancerStudies of the same condition, open and under way.
- More trials run by National Cancer Institute (NCI)The sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 12 participants (actual)
Sponsor and investigators
- Lead sponsor
- National Cancer Institute (NCI)
- Sponsor type
- US National Institutes of Health
- Responsible party
- Sponsor
- Investigators
- Kevin A Camphausen, M.D., Principal investigator, National Cancer Institute (NCI)
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00039624
- Sponsor's protocol ID
- 020207
- Other IDs
- 02-C-0207
- Status last verified
- 31 Jul 2018
- First submitted
- 6 Jun 2002
- Last updated
- 2 Aug 2018
- Results posted
- No
Publications
Hsu IC, Pickett B, Shinohara K, Krieg R, Roach M 3rd, Phillips T. Normal tissue dosimetric comparison between HDR prostate implant boost and conformal external beam radiotherapy boost: potential for dose escalation. Int J Radiat Oncol Biol Phys. 2000 Mar 1;46(4):851-8. doi: 10.1016/s0360-3016(99)00501-5.
PubMed 10705005Martinez AA, Pataki I, Edmundson G, Sebastian E, Brabbins D, Gustafson G. Phase II prospective study of the use of conformal high-dose-rate brachytherapy as monotherapy for the treatment of favorable stage prostate cancer: a feasibility report. Int J Radiat Oncol Biol Phys. 2001 Jan 1;49(1):61-9. doi: 10.1016/s0360-3016(00)01463-2.
PubMed 11163498Cormack RA, Tempany CM, D'Amico AV. Optimizing target coverage by dosimetric feedback during prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2000 Nov 1;48(4):1245-9. doi: 10.1016/s0360-3016(00)00742-2.
PubMed 11072185
Study at a glance
From the registry record, last updated by the sponsor on 2 Aug 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Phase II Study of MR-Guided High Dose Rate Brachytherapy Boosts For Prostate Cancer
- ClinicalTrials.gov ID
- NCT00039624
- Acronym / sponsor ID
- 020207
- Conditions
- Prostate Cancer
- Keywords
- Radiation Therapy, Prostate, MRI, Brachytherapy, Phase II, Prostate Cancer
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 12 participants (actual)
- Lead sponsor
- National Cancer Institute (NCI)US National Institutes of Health
- Study start
- 3 Jun 2002
- Primary completion
- 29 Jul 2004 (actual)
- Study completion
- 31 Jul 2018 (actual)
- First posted
- 7 Jun 2002 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study will evaluate the use of magnetic resonance imaging (MRI) for guiding placement of hollow needles into the prostate gland for delivering internal radiation therapy to patients with prostate cancer. Prostate cancer is often treated with a combination of external beam radiation therapy and brachytherapy (internal radiation delivered close to the tumor). This study will determine whether MRI is more accurate in guiding needle placement than ultrasound, which is currently used for this purpose. Patients will have one brachytherapy treatment followed by 5 weeks of external beam treatments and a second brachytherapy.
Patients 18 years of age and older with prostate cancer that has not spread to the bone may be eligible for this study. Candidates will be screened with a physical examination, blood and urine tests, and a bone scan.
To plan for radiation therapy, patients will have standard computed tomography (CT) and MRI scans of the pelvis and prostate. In addition, CT and MRI scans will be done to determine if the prostate is in a good position for brachytherapy. For these scans, patients will have an enema and a tube will be placed in the rectum. They will then lie still on their side for about 45 minutes during the scan. Patients who have blood in their urine will also undergo cystoscopy. This is an examination of the bladder using a small camera that is advanced through the penis into the bladder.
Patients are given an antibiotic for 2 days before the brachytherapy and on the morning of the procedure. Before the test, they have a small enema and are given medicines through the vein and into the spine for relaxation and to decrease any discomfort. (The test is done under general anesthesia for patients who require it.) The patient is moved on a stretcher into the MRI scanner and a catheter is inserted into the bladder through the penis. The bladder is filled with water and a tube is placed in the rectum. With the help of a plastic guide placed against the skin, about 14 to 18 needles are then placed in the prostate. Some stitches are sewn to hold the needles and the guide in place, and the tube in the rectum is removed. The patient is the transferred from the MR scanner into the CT scanner, where the rectal tube is reinserted and the needles are adjusted. A cystoscopy is done to make sure the needles do not enter the bladder. When the needles are adjusted, the tube is removed from the rectum and the patient is moved to the radiation oncology clinic.
After a few hours, when the radiation dose has been calculated, a radioactive substance called iridium is administered. The needles placed in the prostate are connected to a radiation machine, and thin wires with radioactive material on the tips are inserted into each needle and withdrawn a little at a time. The process takes about 20 to 30 minutes. The patient is then disconnected from the machine and undergoes another MRI scan to confirm the position of the needles. The needles and catheter are then removed and the patient is monitored for a while before going home. Patients then have 5 weeks of external beam therapy, followed by a second brachytherapy treatment.
Patients return to the clinic at 1, 3, 6, 12, 18, 24, 36, 48, and 60 months after treatment for blood tests, physical examination, and review of symptoms.
Detailed description
BACKGROUND
Brachytherapy, the placement of a radioactive source close to a tumor, is rapidly becoming an important modality for patients with prostate cancer because higher and more conformal doses can be safely delivered compared with external beam radiotherapy.
High dose rate (HDR) temporary implants offer several treatment and research based advantages over permanent seeds, including exceptionally complex and accurate dosimetry in reference to anatomic images.
Needle placement in brachytherapy procedures requires detailed image guidance, traditionally obtained with trans-rectal ultrasound (TRUS). MRI offers a 3D dataset, arbitrary imaging planes, and unparalleled soft tissue resolution of the anatomy, making it the modality of choice for imaging the prostate gland.
A real-time MR-guided prostate permanent seed implant technique that utilizes both real-time MRI and real-time dosimetry has been designed, implemented and reported. Results confirm that TRUS-guided implants may be improved upon by using MRI. To our knowledge, HDR implants have not yet been performed under MR guidance in a closed bore magnet.
OBJECTIVES
The primary objective is to determine the quality of prostate HDR brachytherapy implants performed under MR-guidance.
Quality is defined by the percentage of the planning target volume (PTV) encompassed by a given percentage of the prescribed dose. In this study an implant will be of "acceptable" quality if 80% of the PTV is encompassed by the 100% isodose (V100 80%), in accordance with RTOG guidelines.
ELIGIBILITY
Pathologically confirmed prostate cancer with the following features:
- Gleason score greater than 6, or greater than T2a, or
- PSA greater than or equal to 10, and no evidence of bone metastases;
Age greater than or equal to 18 years;
ECOG performance status of 0 or 1
DESIGN
The study is designed with a "run-in" pilot phase with the objective of refining the technique.
The evaluation phase is a two-stage optimal design to evaluate the quality of the implant with an early look for futility.
This study has the potential to enroll a maximum of 27 patients.
Radiation treatment parameters will be patterned after established guidelines in the literature such as those reported by the American Brachytherapy Society and the William-Beaumont Hospital. There will be no attempted dose escalation or attempts to prescribe the dose to unconventional target volumes in this phase of the project.
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Brachy | Experimental | Radiation: Brachytherapybrachytherapy |
Who may qualify
- Ages
- 18 to 90 years
- Sex
- Male only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Pathologically confirmed prostate cancer with the following features: Gleason score greater than 6, or greater than T2a, or PSA greater than or equal to 10, and no evidence of bone metastases
- 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).
Key exclusion criteria (15 listed)
- History of prior pelvic or prostate radiotherapy
- TURP within the last 6 months or large TURP defect
- Bleeding disorder
- Active anticoagulation at the time of implant
- Artificial heart valve
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| BrachytherapyPatients will receive two HDR brachytherapy implants (950-1050 cGy/implant) before and at the end of a course of external beam radiotherapy (4600 cGy, 2Gy/day). | Radiation | Brachy |
Primary outcome
To evaluate the quality of brachytherapy implants performed under MR-guidance.
Time frame: 60 months
3 secondary outcomes
To document patient tolerance and treatment toxicities associated with our EBRT + MR-Guided brachytherapy boost technique.
Time frame: 60 months
To measure the magnitude of spatial distortion in MR images and it's impact on dosimetric accuracy
Time frame: 60 months
To document time to biochemical failure and survival distributions in this group of patients.
Time frame: 60 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Aug 2018.
- Background: PubMed 10705005Hsu IC, Pickett B, Shinohara K, Krieg R, Roach M 3rd, Phillips T. Normal tissue dosimetric comparison between HDR prostate implant boost and conformal external beam radiotherapy boost: potential for dose escalation. Int J Radiat Oncol Biol Phys. 2000 Mar 1;46(4):851-8. doi: 10.1016/s0360-3016(99)00501-5.
- Background: PubMed 11163498Martinez AA, Pataki I, Edmundson G, Sebastian E, Brabbins D, Gustafson G. Phase II prospective study of the use of conformal high-dose-rate brachytherapy as monotherapy for the treatment of favorable stage prostate cancer: a feasibility report. Int J Radiat Oncol Biol Phys. 2001 Jan 1;49(1):61-9. doi: 10.1016/s0360-3016(00)01463-2.
- Background: PubMed 11072185Cormack RA, Tempany CM, D'Amico AV. Optimizing target coverage by dosimetric feedback during prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2000 Nov 1;48(4):1245-9. doi: 10.1016/s0360-3016(00)00742-2.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Kevin A Camphausen, M.D. principal investigator
National Cancer Institute (NCI)
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Brachytherapy in people with Prostate Cancer, run by National Cancer Institute (NCI) at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 2 Aug 2018. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
To evaluate the quality of brachytherapy implants performed under MR-guidance. (time frame: 60 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00039624, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Aug 2018.