Ablative tReatment of Inoperable REnal Cell Carcinoma Using STereotactic Body Radiotherapy (ARREST-study)
Trial Snapshot
- Phase
- Phase 2
- Status
- Terminated
- Sponsor
- UMC Utrecht
- Enrollment
- 30
- Locations
- 1
- Primary Endpoint
- Number of participants with treatment related adverse events grade >2 as assessed by CTCAE v.4.0
Study Overview
Brief Summary
Phase II study (n=30) to evaluate the safety and feasibility of stereotactic body radiation therapy (SBRT) with fiducial markers in inoperable patients with renal cell carcinoma (RCC).
Detailed Description
Rationale: The standard treatment of RCC is (partial-) nephrectomy. Alternatives to this treatment are less invasive techniques like radio frequency ablation (RFA) and cryoablation (CA). Stereotactic body radiation therapy (SBRT) is an alternative curative treatment modality, which has shown promising results in several North-American phase I-II studies over the last years. In this study, we aim to evaluate the safety and feasibility of SBRT for patients with inoperable RCC on a conventional cone beam computed tomography (CBCT) linear accelerator.
Objective: To evaluate safety and feasibility of stereotactic body radiation therapy (SBRT) with fiducial markers in inoperable patients with renal cell carcinoma (RCC).
Study design: Single arm prospective study. Study population: Inoperable patients ≥ 18 years, with a pathology proven RCC fulfilling the inclusion criteria.
Intervention: Prior to treatment, patients will undergo fiducial marker placement (in combination with a biopsy, if RCC has not been pathology proven), followed by a contrast enhanced planning computed tomography (CT)-scan and a contrast enhanced MRI-scan. Fiducial markers will be used as this increases visibility of the tumor and therefore the accuracy of radiotherapy, particularly the irradiated healthy kidney tissue will be diminished by using this approach. Baseline toxicity and quality of life will be assessed.
SBRT using a VMAT technique will be delivered in five fractions of 7 Gy every other day. The target volume for treatment is defined on a 4D planningCT and MRI and the tumor is treated in the midposition of the breathing cycle. After treatment, follow-up will be at 1, 3, 6 and 12 months at the Radiotherapy department, followed by standard follow-up by the urologist. An additional contrast enhanced MRI scan will be performed after the 2nd treatment fraction, and after 6 and 12 months to assess treatment response to prepare for future MR-guided (MR-linac) radiotherapy. Toxicity and quality of life will be assessed during follow-up.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 100 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Inoperability, or when a patient refuses surgery (i.e. not eligible for (partial-) nephrectomy or RFA);
- •Kidney function allows for intervention, as evaluated by treating urologist (taking into account eGFR and renogram);
- •Age ≥ 18 years;
- •Written informed consent;
- •Diagnosis of RCC confirmed by pathology (in case determined after informed consent, patients who are not eligible anymore (no RCC) will be excluded).
Exclusion Criteria
- •Evidence of metastatic disease;
- •Exclusion criteria for contrast enhanced MRI scan, according to the protocol of the department of Radiology, UMC Utrecht;
- •Patients with one functioning kidney;
- •Prior renal surgery (partial nephrectomy);
- •Prior radiotherapy on upper abdomen;
- •Unsafe to have fiducial marker implantation: i.e. anticoagulant agents use other than acetylsalicyl acid, which cannot be safely stopped/bridged for implantation:
- •Chemotherapy < 3 weeks before treatment;
- •Targeted therapy (sunitinib, etc.) ≤ 7 days before treatment.
Arms & Interventions
ARREST-study
SBRT renal cell carcinoma 5 times 7Gy
Intervention: ARREST-study (Radiation)
Outcomes
Primary Outcomes
Number of participants with treatment related adverse events grade >2 as assessed by CTCAE v.4.0
Time Frame: Within 90 days after radiotherapy
The treatment is considered successful if all 5 treatments are completed and if in total \<15% of the patients (=5 patients) report an acute toxicity ≤ grade 3
Secondary Outcomes
- Quality of life questionnaire(12 months after radiotherapy)
- Overall survival(5 years after radiotherapy)
- Disease specific survival(5 years after radiotherapy)
- Radiological response(5 years after radiotherapy)
- Number of participants with correlation of functional MRI (DCE and DWI) changes during treatment and radiological response after treatment(12 months after radiotherapy)
- Acute and late toxicity(5 years after radiotherapy)
Investigators
L.G.W. Kerkmeijer
MD, PhD
UMC Utrecht