Effect of High Doses of Radiation on Bone Structure and Metabolism

Not Applicable

Completed

Conditions: Malignant Bone Tumors

Interventions: Radiation: Radiation (Non-surgical Arm)
Radiation: Radiation (Surgical Arm)
Procedure: Malignant Tumor Surgery

Registration Number: NCT02323295

Lead Sponsor: Massachusetts General Hospital

Brief Summary: This study is designed to characterize the effects of high energy radiation on bone breakdown, with a specific interest in reducing the rate of sacral fractures. Although radiation is very important in managing tumors, it is related to complications such as bone fractures. In this research study, the investigators are looking to determine changes in blood markers, bone density, and bone structure following radiation and to better understand the reason for these changes.

Detailed Description: Participants in the Surgical Arm of the study will be treated according to the schedule outlined in protocol for a combined treatment with surgery and adjuvant high dose radiotherapy. Patients in the non surgical arm of the the study will be treated according to the protocol being treated with radiotherapy alone.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 12

Inclusion Criteria

All laboratory tests that are a part of the eligibility criteria must be completed within 14 days prior to the date of registration. Diagnostic tests that are a part of the eligibility criteria must be performed within 30 days of the date of registration. Participants must meet the following criteria on screening examination to be eligible to participate in the study:
Study participants must have histologically confirmed primary malignant bone tumor in the sacrum for which surgery and radiation or radiation alone are planned.
Age 18 years or older. In children under the age of 8, tetracycline derivatives have been reported to stain tooth enamel yellow color. These considerations lead us to exclude young persons under the age of 18 from the study.
Participants must have normal organ and marrow function as defined below:
- Total bilirubin within normal institutional limits
- Aspartaataminotransferase (AST) (SGOT)/ Alanine-aminotransferase (ALT) (SGPT) < 2.5 X institutional upper limit of normal
- Creatinine within normal institutional limits or creatinine clearance > 60 mL/min/1.73 m2 for subjects with creatinine levels about institutional normal limit
The effects of tetracyclines and radiation used in computer tomography on the developing human fetus are known to be detrimental. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
Participants must be able to read and understand English language and have the ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria

Participants who exhibit any of the following conditions at screening will not be eligible for admission into the study.

Participants who have had surgery, chemotherapy, or radiotherapy of the sacrum prior to entering the study
History of allergic reactions attributed to compounds of similar chemical or biologic composition to tetracyclines.
Pregnant or nursing
Uncontrolled inter current illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Non Surgical-Radiation Only	Radiation (Non-surgical Arm)	Non-surgical candidates receive 72 up to 77.l4 Gy of radiation depending on the histology (72 Gy for osteosarcoma and chondrosarcoma and 77.4 Gy for chordoma
Malignant Tumor Surgery And Radiation	Radiation (Surgical Arm)	The standard treatment includes pre-operative radiation of 50.4 Gy, followed by a recovery period of approximately 4 to 5 weeks. Surgery involves removing the malignant tumor in the sacrum in one piece, preferably with a cuff of normal tissue around the tumor. After approximately 6 weeks of recovery, the patient is treated with another 19.8 Gy up to 27 Gy of radiation postoperatively depending on the final margin status (higher for gross residual disease). If the wound is not healed or there is another medical reason to delay adjuvant radiation, then radiation may begin later.
Malignant Tumor Surgery And Radiation	Malignant Tumor Surgery	The standard treatment includes pre-operative radiation of 50.4 Gy, followed by a recovery period of approximately 4 to 5 weeks. Surgery involves removing the malignant tumor in the sacrum in one piece, preferably with a cuff of normal tissue around the tumor. After approximately 6 weeks of recovery, the patient is treated with another 19.8 Gy up to 27 Gy of radiation postoperatively depending on the final margin status (higher for gross residual disease). If the wound is not healed or there is another medical reason to delay adjuvant radiation, then radiation may begin later.

Primary Outcome Measures

Name	Time	Method
Change in Bone Mineral Density (Tb. BMD)	Non-surgical arm: baseline, 3 months Surgical arm: baseline, 9 weeks	Trabecular bone mineral density will be measured in mg/cm3 using volumetric Quantitative Computed Tomography (QCT) of L1, L2 and the vertebrae adjacent to the tumor.

Secondary Outcome Measures

Name	Time	Method
Serum Phosphate (P)	Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months	Indicators for systemic metabolism that can affect bone health, units reported in mg/dL
Serum 25-hydroxycalciferol Vit D (25-OH VitD)	Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months	Indicators for systemic metabolism that can affect bone health, units reported in nmol/L
Osteoclast Number (N.Oc/BPm)	Only surgical arm: The weeks after biopsies are taken during surgery (surgery is during week 4 and 5).	Immunohistochemistry staining methods will be used and the unit of measure will be mm\^-1
Osteoclast Surface (Oc.S/BS)	Only surgical arm: The weeks after biopsies are taken during surgery (surgery is during week 4 and 5).	Immunohistochemistry staining methods will be used and the unit of measure will be mm\^-1
Serum N-Telopeptide (NTX)	Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months	Indicator for Bone Formation, units reported in nmol NTX/mmol creatinine
Serum Tartrate-resistant Acid Phosphatase 5b (TRAP5b)	Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months	Indicator for Bone Formation, units reported in U/L
Serum Osteocalcin (OC)	Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months	Indicator for Bone Formation, units reported in ng/mL
Serum Type 1 Procollagen N-terminal (P1NP)	Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months	Indicator for systemic metabolism that can affect bone health, units reported in pg/mL
Mineral Apposition Rate (MAR)	Only surgical arm: The months after biopsies are taken during surgery (surgery is during week 4 and 5). These measurements will be done in batches so timeframe isn't clear.	Tetracycline quadruple labeling method will be used and the unit of measure will be um/day
Bone Formation Rate (BFR/BS)	Only surgical arm: The months after biopsies are taken during surgery (surgery is during week 4 and 5). These measurements will be done in batches so timeframe isn't clear.	Tetracycline quadruple labeling method will be used and the unit of measure will be mm3/mm2/year
Mineralization Lag Time (Mlt)	Only surgical arm: The months after biopsies are taken during surgery (surgery is during week 4 and 5). These measurements will be done in batches so timeframe isn't clear.	Tetracycline quadruple labeling method will be used and the unit of measure will be days
Osteoblast Number (N.Ob/BPm)	Only surgical arm: The weeks after biopsies are taken during surgery (surgery is during week 4 and 5).	Immunohistochemistry staining methods will be used and the unit of measure will be mm\^-1
Osteoblast Surface (Ob. S/BS)	Only surgical arm: The weeks after biopsies are taken during surgery (surgery is during week 4 and 5).	Immunohistochemistry staining methods will be used and the unit of measure will be mm\^-1