Hypofractionated Radiation Therapy for Treating Prostate Cancer High-Risk Features Following Radical Prostatectomy
- Conditions
- Prostate AdenocarcinomaStage III Prostate Cancer AJCC v8Stage IIB Prostate Cancer AJCC v8Stage IIIA Prostate Cancer AJCC v8Stage IIIB Prostate Cancer AJCC v8Stage IIIC Prostate Cancer AJCC v8
- Interventions
- Radiation: Hypofractionated Radiation TherapyDrug: Androgen SuppressionOther: Quality-of-Life AssessmentOther: Questionnaire Administration
- Registration Number
- NCT03570827
- Lead Sponsor
- Mayo Clinic
- Brief Summary
This phase II trial studies how well hypofractionated radiation therapy works in treating participants with prostate cancer high-risk features following radical prostatectomy. Hypofractionated radiation therapy delivers higher doses of radiation therapy over a shorter period of time and may kill more tumor cells and have fewer side effects.
- Detailed Description
PRIMARY OBJECTIVE:
I. To determine if stereotactic body radiation therapy (SBRT) would result in similar freedom from failure (FFF) than standard fractionation photon therapy.
EXPLORATORY OBJECTIVES:
I. After completion of radiation therapy, determine the incidence of grade 2 or greater genitourinary (GU) and gastrointestinal (GI) toxicity at 6 months (Common Terminology Criteria for Adverse Events \[CTCAE\] version 4).
II. After completion of radiation therapy, determine the incidence of grade 3 or greater GU and GI toxicity at 6 months (CTCAE version 4).
III. After completion of radiation therapy, determine the incidence of quality of life issues following completion of radiation therapy.
IV. After completion of radiation therapy, determine the incidence of impotence after the use of radiation therapy at 3 years.
V. After completion of radiation therapy, determine the incidence of freedom from biochemical failure (FFBF) at 5 years.
VI. After completion of radiation therapy, determine the incidence of clinical failure: local and/or distant at 5 years.
VII. After completion of radiation therapy, determine the incidence of salvage androgen deprivation use (SAD) at 5 years.
VIII. After completion of radiation therapy, determine the incidence of progression free survival: using clinical, biochemical and SAD as events at 5 years.
IX. After completion of radiation therapy, determine the incidence of overall survival at 5 years.
X. After completion of radiation therapy, determine the incidence of disease-specific survival at 5 years.
XI. Determine the impact of radiation therapy on quality of life. XII. Determine overall GI and GU toxicity. XIII. Determine prostate and normal structure movement during radiation therapy (RT) with the use of scans.
XIV. Correlate pathologic and radiologic findings with outcomes. XV. Correlate pre-RT prostate specific antigen (PSA) levels with outcomes. XVI. Correlate variation in proton therapy or x-ray dosimetry and outcomes. XVII. Develop a quality assurance process for prostate proton therapy. XVIII. Prospectively collect information that will help to define dose-volume relationships of normal structures with acute and chronic toxicity.
XIX. Allow for future research of pathologic risk factors that may influence prognosis; this information will help us to attempt to characterize their presence in prostate cancer with high risk features after prostatectomy and their potential effect on outcomes.
XX. Possibly compare dosimetric parameters of an IMRT plan with the proton therapy radiation plan.
OUTLINE: Participants are assigned to 1 of 3 groups.
GROUP I: Participants undergo hypofractionated radiation therapy over 15-30 minutes every other day over 2 weeks, for 5 treatments.
GROUP II: Beginning 8-10 weeks before radiation therapy, participants receive androgen suppression therapy subcutaneously (SC) or intramuscularly (IM) for up to 6 months (at the discretion of the treating physician). Participants then undergo hypofractionated radiation therapy as Group I.
GROUP III: Participants receive androgen suppression therapy as Group II for up to 18 months (at the discretion of the treating physician), then undergo hypofractionated radiation therapy over 15-30 minutes every other day over 1-2 weeks, for 1-5 treatments.
After completion of study treatment, participants are followed up at 3 and 12 months, annually for 4 years, then every 2 years thereafter.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Male
- Target Recruitment
- 52
- Histologically confirmed prostate adenocarcinoma at the time of surgery
- Pathologic stages T2-T3b, N0-Nx-N1, M0-1 as staged by the pathology report (American Joint Committee on Cancer [AJCC] criteria 8th edition [Ed.])
- One or more high risk features including: seminal vesicle invasion, extracapsular extension, positive margins, or a PSA post surgery between 0.2 and < 2.0
- PSA values < 2 ng/ml within 90 days prior to enrollment. Obtained at least 6 weeks after surgery
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2 assessed within 90 days of enrollment
- Patients must sign Institutional Review Board (IRB) approved study specific informed consent
- Patients must complete all required pre-entry tests within the specified time frames
- Patients must be able to start treatment (androgen suppression [AS] or radiation) within 120 days of study registration
- Members of all races and ethnic groups are eligible for this trial
- Patients from outside of the United States may participate in the study
- Previous pelvic radiation
- Prior androgen suppression therapy for prostate cancer for more than 6 months
- Active rectal diverticulitis, Crohn's disease affecting the rectum or ulcerative colitis (non-active diverticulitis and Crohn's disease not affecting the rectum are allowed)
- Prior systemic chemotherapy for prostate cancer
- History of proximal urethral stricture requiring dilatation
- Current and continuing anticoagulation with warfarin sodium (coumadin), heparin, low- molecular weight heparin, Clopidogrel bisulfate (plavix), or equivalent (unless it can be stopped to manage treatment related toxicity, to have a biopsy if needed, or place markers)
- Major medical, addictive or psychiatric illness which in the investigator's opinion, will prevent the consent process, completion of the treatment and/or interfere with follow-up. (Consent by legal authorized representative is not permitted for this study)
- Evidence of any other cancer within the past 5 years and < 50% probability of a 5 year survival. (Prior or concurrent diagnosis of basal cell or non-invasive squamous cell cancer of the skin is allowed)
- History of myocardial infarction or decompensated congestive heart failure (CHF) within the last 6 months
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Group I (hypofractionated radiation therapy) Hypofractionated Radiation Therapy Participants undergo hypofractionated radiation therapy over 15-30 minutes every other day over 2 weeks, for 5 treatments. Group I (hypofractionated radiation therapy) Quality-of-Life Assessment Participants undergo hypofractionated radiation therapy over 15-30 minutes every other day over 2 weeks, for 5 treatments. Group I (hypofractionated radiation therapy) Questionnaire Administration Participants undergo hypofractionated radiation therapy over 15-30 minutes every other day over 2 weeks, for 5 treatments. Group II (radiation therapy, androgen suppression therapy) Androgen Suppression Beginning 8-10 weeks before radiation therapy, participants receive androgen suppression therapy SC or IM for up to 6 months (at the discretion of the treating physician). Participants then undergo hypofractionated radiation therapy as Group I. Group II (radiation therapy, androgen suppression therapy) Hypofractionated Radiation Therapy Beginning 8-10 weeks before radiation therapy, participants receive androgen suppression therapy SC or IM for up to 6 months (at the discretion of the treating physician). Participants then undergo hypofractionated radiation therapy as Group I. Group II (radiation therapy, androgen suppression therapy) Quality-of-Life Assessment Beginning 8-10 weeks before radiation therapy, participants receive androgen suppression therapy SC or IM for up to 6 months (at the discretion of the treating physician). Participants then undergo hypofractionated radiation therapy as Group I. Group II (radiation therapy, androgen suppression therapy) Questionnaire Administration Beginning 8-10 weeks before radiation therapy, participants receive androgen suppression therapy SC or IM for up to 6 months (at the discretion of the treating physician). Participants then undergo hypofractionated radiation therapy as Group I. Group III (radiation therapy, androgen suppression therapy) Androgen Suppression Participants receive androgen suppression therapy as Group II for up to 18 months (at the discretion of the treating physician), then undergo hypofractionated radiation therapy over 15-30 minutes every other day over 1-2 weeks, for 1-5 treatments. Group III (radiation therapy, androgen suppression therapy) Hypofractionated Radiation Therapy Participants receive androgen suppression therapy as Group II for up to 18 months (at the discretion of the treating physician), then undergo hypofractionated radiation therapy over 15-30 minutes every other day over 1-2 weeks, for 1-5 treatments. Group III (radiation therapy, androgen suppression therapy) Quality-of-Life Assessment Participants receive androgen suppression therapy as Group II for up to 18 months (at the discretion of the treating physician), then undergo hypofractionated radiation therapy over 15-30 minutes every other day over 1-2 weeks, for 1-5 treatments. Group III (radiation therapy, androgen suppression therapy) Questionnaire Administration Participants receive androgen suppression therapy as Group II for up to 18 months (at the discretion of the treating physician), then undergo hypofractionated radiation therapy over 15-30 minutes every other day over 1-2 weeks, for 1-5 treatments.
- Primary Outcome Measures
Name Time Method Freedom from failure (FF) Up to 5 years Will be defined as the first occurrence of clinical failure (local recurrence, regional recurrence, or distant metastasis), the start/re-start of salvage therapy including androgen suppression, and biochemical failure (PSA \>= 0.5 ng/ml).
- Secondary Outcome Measures
Name Time Method Acute grade 2 or higher and grade 3 or higher genitourinary (GU) and gastrointestinal (GI) toxicity Up to 5 years Assessed using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4 criteria. The maximum grade for each type of acute adverse events (AE) will be recorded for each patient.
Grade 2 or higher and grade 3 or higher GI and GU toxicity 3 years Will be performed using NCI CTCAE v4 criteria. The maximum grade for each type of acute adverse events (AE) will be recorded for each patient.
Local/distant failure Start of treatment assessed up to 5 years Will be measured from the treatment start date to the date of documented local failure as determined either by clinical exam, imaging, or by prostate re-biopsy.
Distant metastasis Up to 5 years Distant metastasis is cancer that has spread from the original (primary) tumor location to distant organs or distant lymph nodes.
Quality of life (QOL) Up to 5 years Summation of relative scores for quality of life items from the Expanded Prostate Cancer Index Composite (EPIC) instrument will be used to measure each individual's quality of life. The EPIC questionnaire is designed to measure Quality of Life issues in patients with Prostate Cancer. The questionnaire consists of 32 questions in 5 domains. Each question is answered on a 5-point scale such as 0-4 where 1=no problem and 4=big problem.
Impotence at 3 years Up to 3 years after completion of radiation therapy Summation of relative scores for sexual function items (items 31 through 39) from the Expanded Prostate Cancer Index Composite (EPIC) instrument will be used to measure each individual's quality of life. The EPIC questionnaire is designed to measure Quality of Life issues in patients with Prostate Cancer. The questionnaire consists of 32 questions in 5 domains. Each question is answered on a 5-point scale such as 0-4 where 1=no problem and 4=big problem.
Salvage androgen suppression use at 5 years Up to 5 years following completion of radiation therapy Will be assessed by the number of patients using salvage androgen deprivation use (SAD) at 5 years post radiation therapy
Progression free survival Up to 5 years Will use clinical, biochemical and SAD as events. Will be estimated with a Kaplan-Meier estimator and curve. Estimates will be given for specific time points along with 95% CIs.
Disease-free survival Up to 5 years Will be estimated with a Kaplan-Meier estimator and curve. Estimates will be given for specific time points along with 95% CIs.
Freedom from biochemical failure (FFBF) Up to 5 years Biochemical failure is defined as a rise in prostate-specific antigen (PSA) levels after treatment, indicating that the cancer may be recurring or progressing.
Overall survival at 5 years Up to 5 years Overall survival is defined as the time from enrollment until death due to any cause.
Trial Locations
- Locations (2)
Mayo Clinic in Arizona
🇺🇸Scottsdale, Arizona, United States
Mayo Clinic in Rochester
🇺🇸Rochester, Minnesota, United States
Mayo Clinic in Arizona🇺🇸Scottsdale, Arizona, United States