A Study of IMRT in Primary Bone and Soft Tissue Sarcoma
- Conditions
- Ewing SarcomaChordomaSoft Tissue Sarcoma, AdultBone Sarcoma
- Interventions
- Radiation: Intensity modulated radiotherapy (IMRT)
- Registration Number
- NCT02520128
- Lead Sponsor
- University College, London
- Brief Summary
IMRiS is a phase II trial which aims to assess the feasibility, efficacy and toxicity of Intensity Modulated Radiotherapy (IMRT) in three different cohorts of patients with primary bone and soft tissue sarcoma and to demonstrate whether IMRT can improve on current clinical outcomes.
Cohort 1 of the trial is now closed to recruitment.
- Detailed Description
IMRiS is a prospective multicentre phase II trial of Intensity Modulated Radiotherapy (IMRT). The trial is aiming to evaluate the role of intensity modulated radiotherapy (IMRT) in soft tissue and bone sarcomas. Three separate sarcoma cohorts will be studied and will be analysed separately. Patients will be enrolled in one of three cohorts depending on the type of sarcoma they have:
Cohort 1- Patients with Limb/limb girdle soft tissue sarcoma receiving (neo)-adjuvant radiotherapy. (closed to recruitment)
Cohort 2- Patients with Ewing sarcoma of the spine/pelvis receiving definitive radical or (neo)-adjuvant radiotherapy.
Cohort 3- Patients with non-Ewing primary bone sarcomas of the spine/pelvis receiving definitive radical or adjuvant radiotherapy.
Dose schedules for each Cohort have been indicated in the Trial Arm description.
Radiotherapy will be delivered with fixed beam IMRT, arc IMRT techniques, or tomotherapy. All trial patients will be followed up until death or a maximum of three years from the date of registration in the trial.
The theoretical advantage to IMRT is the potential reduction in late toxicity and subsequent potential for functional improvement. There have been no prospective studies to date powered to address this, particularly where IMRT is used post-operatively. IMRiS cohort 1 will address this question and establish if the use of IMRT will reduce late normal tissue toxicity.
In cohorts 2 \& 3, the aim is to establish if the use of IMRT will enable the achievement of a radiotherapy treatment plan that delivers the optimal dose while keeping within normal tissue tolerances. There have been no clinical trials of IMRT in Ewing sarcoma and there is very little published on the use of IMRT in high grade bone sarcomas and chordomas. It is important to establish the feasibility of IMRT to achieve the required radiation doses to the tumour, and to prospectively document the side effects of treatment in this setting. IMRiS will address this in cohort 2 and cohort 3.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 191
-
Histologically proven soft tissue sarcoma of the upper or lower limb or limb girdle (Cohort 1), OR,
Ewing sarcoma of bone arising in the pelvis or spine (Cohort 2) , OR,
High grade primary bone sarcoma (non-Ewing) or Chordoma arising in the pelvis/spine (Cohort 3)
-
Patients requiring (neo)adjuvant or definitive radical radiotherapy
-
WHO performance status 0-2
-
Patients aged 16 years or more
-
Patients fit enough to undergo radiotherapy treatment and willing to attend follow up visits as per protocol
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Women of child-bearing potential must have a negative pregnancy test prior to trial entry. Female patients of child-bearing potential and male patients with partners of child-bearing potential must agree to use adequate contraception methods, which must be continued for 3 months after completion of treatment.
-
Capable of giving written informed consent
- Previous radiotherapy to the same site
- Patients receiving concurrent chemotherapy with radiotherapy (neo-adjuvant chemotherapy prior to radiotherapy is permitted.
- Patient with bone sarcomas eligible for proton beam radiotherapy; N.B. if a patient is not to have PBRT for whatever reason, they may be considered for IMRiS.
- Paediatric type alveolar or embryonal rhabdomyosarcomas
- Pregnancy (Women of child-bearing potential must have a negative pregnancy test prior to trial entry. Female patients of child-bearing potential and male patients with partners of child-bearing potential must agree to use adequate contraception methods, which must be continued for 3 months after completion of treatment
- Patients with concurrent or previous malignancy that could compromise assessment of the primary and secondary endpoints of the trial; these cases must be discussed with UCL CTC prior to the patient being approached.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Cohort 2 Intensity modulated radiotherapy (IMRT) Cohort 2: Patients with Ewing sarcoma of the spine/pelvis receiving definitive radical or (neo)-adjuvant radiotherapy (Intensity Modulated Radiotherapy) Dose schedules for Cohort 2: * Pre-operative RT - 50.4 Gy in 28 daily fractions over 5½ weeks * Post-operative RT - 54 Gy in 30 daily fractions over 6 weeks * Primary RT - 54 Gy in 30 daily fractions over 6 weeks. Cohort 3 Intensity modulated radiotherapy (IMRT) Cohort 3: Patients with non-Ewing primary bone sarcomas of the spine/pelvis receiving definitive radical or adjuvant Radiotherapy (Intensity Modulated Radiotherapy) Dose schedule for Cohort 3: * Primary RT - 70 Gy in 35 daily fractions over 7 week * Post-operative RT (non-chordoma) - primary bone sarcoma 60 Gy in 30 daily fractions over 6 weeks * Post-operative RT (chordoma) - 70 Gy in 35 daily fractions over 7 weeks. Cohort 1 (closed to recruitment) Intensity modulated radiotherapy (IMRT) Cohort 1: Patients with Limb/limb girdle soft tissue sarcoma (STS) receiving (neo)-adjuvant radiotherapy (Intensity Modulated Radiotherapy) Dose schedules for Cohort 1: * Pre-operative RT - 50 Gy in 25 daily fractions over 5 weeks * Post-operative RT - 60 Gy in 30 daily fractions to the high dose planning target volume (PTV) and 52.2 Gy in 30 daily fractions to the low dose PTV treated concurrently over 6 weeks * Post-operative RT (positive resection margins) - 66 Gy in 33 daily fractions to the high dose PTV, and 53.46Gy in 33 fractions to the low dose PTV treated concurrently over 6 ½ weeks.
- Primary Outcome Measures
Name Time Method Cohort 1 (limb soft tissue sarcomas): The rate of grade 2 or more late soft tissue fibrosis at 2 years following radiotherapy as assessed by RTOG late radiation morbidity criteria. From date of registration until 2 years after date of registration. Late toxicity assessment measured using RTOG late radiation morbidity criteria.
Cohort 3 (Non-Ewing's primary bone sarcomas of the spine/pelvis): The proportion of patients in whom 80% of the planPTV receives 95% of the optimal prescription dose. Upon completion of IMRT treatment Cohort 3 (Non-Ewing's primary bone sarcomas of the spine/pelvis): The proportion of patients in whom 80% of the planPTV receives 95% of the optimal prescription dose.
Cohorts 2 (Ewing's sarcoma of the spine/pelvis): The proportion of patients in whom 90% of the planPTV receives 95% of the optimal prescription dose. Upon completion of IMRT treatment Cohorts 2 (Ewing's sarcoma of the spine/pelvis): The proportion of patients in whom 90% of the planPTV receives 95% of the optimal prescription dose.
- Secondary Outcome Measures
Name Time Method Time to local disease progression (Cohorts 2 and 3, for definitive radical RT) From date of registration to date of documented progression (assessed up to 3 years from date of registration) Time to local disease progression evaluation from date of registration to first diagnosis of progression.
Patient reported Quality of life (QOL) - (All cohorts) Timepoints- Baseline, 1 year and 2 year post treatment All cohorts, patient reported Quality of life measured using EORTC QLQ-C30 quality of life questionnaire
Overall survival (All Cohorts) From date of registration to date of death or date of last follow-up assessment (assessed up to 3 years from date of registration) Overall survival time will be calculated from date of registration to the date of death from any cause or end of trial follow up
Acute RT toxicity - (For all cohorts) From date of registration up to 90 days after date of registration In all 3 cohorts, Acute RT toxicity measured using RTOG acute radiation morbidity criteria.
Late RT toxicity - (For all cohorts) From Day 91 after date of registration up to 3 years after date of registration In all 3 cohorts, late toxicities measured using the RTOG/EORTC Late Radiation Morbidity Scoring Criteria (skin, subcutaneous tissue fibrosis, bone, joint stiffness) and Stern's scale for oedema
Disease free survival (All Cohorts) The start date for analysis will be the date of registration. From date of registration to date of documented disease progression assessed up to 3 years from date of registration Disease free survival will be calculated from the date of registration to date of documented disease progression, or death from any cause. Where progression is suspected and subsequently confirmed by scans, the date of documented suspected progression will be used. Patients alive and disease-free will be censored at the date last seen.
Time to local tumour recurrence (All Cohorts, for adjuvant RT) From date of registration to date of documented recurrence within the irradiated site (assessed up to 3 years from date of registration) Time to local tumour recurrence evaluation from date of registration to first diagnosis of recurrence (histological or radiological).
For individual plans (cohort 2 & 3) Upon completion of IMRT treatment. Dose delivered to 95%, 80%, 70%, 60% and 50% volume of planPTV.
Patient reported limb function (Cohort 1 only) At timepoints - Baseline, 1 year and 2 years post Treatment For patients in Cohort 1 only, patient reported limb function measured using TESS questionnaire
Wound complications within 120 days of surgery (Cohort 1 only) From date of definitive surgery until 120 days post surgery Rate and severity of wound complications assessed up to 120 days post surgery. This is a composite outcome measure assessed by a clinical examination of the wound.
Response by RECIST 1.1 (Cohorts 2 and 3, for definitive radical RT) From date of registration to date of documented progression (assessed up to 3 years from date of registration) Response measured according to RECIST v 1.1 (for definitive radical RT)
Trial Locations
- Locations (28)
St Luke's Hospital
🇮🇪Dublin, Ireland
Bristol Haematology and Oncology Centre
🇬🇧Bristol, United Kingdom
Beatson West of Scotland Cancer Centre
🇬🇧Glasgow, United Kingdom
University College London Hospitals
🇬🇧London, United Kingdom
Clatterbridge Cancer Centre
🇬🇧Bebington, United Kingdom
Belfast City Hospital
🇬🇧Belfast, United Kingdom
Queen Elizabeth Hospital
🇬🇧Birmingham, United Kingdom
Royal Derby Hospital
🇬🇧Derby, United Kingdom
Velindre Hospital
🇬🇧Cardiff, United Kingdom
Cheltenham Hospital
🇬🇧Cheltenham, United Kingdom
Royal Devon & Exeter Foundation Trust
🇬🇧Exeter, United Kingdom
Adenbrookes' Hospital
🇬🇧Cambridge, United Kingdom
University Hospital Coventry
🇬🇧Coventry, United Kingdom
Western General Hospital
🇬🇧Edinburgh, United Kingdom
St James' Institute of Oncology
🇬🇧Leeds, United Kingdom
Leicester Royal Infirmary
🇬🇧Leicester, United Kingdom
The Christie Hospital
🇬🇧Manchester, United Kingdom
Northern Centre for Cancer Care
🇬🇧Newcastle, United Kingdom
Northampton General Hospital
🇬🇧Northampton, United Kingdom
Churchill Hospital
🇬🇧Oxford, United Kingdom
Norfolk and Norwich University Hospital
🇬🇧Norwich, United Kingdom
Nottingham City Hospital
🇬🇧Nottingham, United Kingdom
Royal Preston Hospital
🇬🇧Preston, United Kingdom
Derriford Hospital
🇬🇧Plymouth, United Kingdom
Southampton General Hospital
🇬🇧Southampton, United Kingdom
Weston Park Hospital
🇬🇧Sheffield, United Kingdom
The Royal Marsden NHS Foundation Trust
🇬🇧Sutton, United Kingdom
Singleton Hospital
🇬🇧Swansea, United Kingdom