A Randomized Phase II Study Comparing Intensity Modulated External Beam Radiation Therapy (IMRT) Versus Permanent Interstitial Prostate Brachytherapy (PIPB) for Low Risk and Low-tier Intermediate Risk Prostate Cancer
试验速览
- 阶段
- 不适用
- 入组人数
- 50
- 试验地点
- 2
- 主要终点
- The primary end point of this study is the acute and late toxicities of the therapeutic interventions.
研究概览
简要总结
Purpose:
The purpose of this trial is to compare two different treatment options for patients with low risk and low-tier intermediate risk prostate cancer. The two treatment arms being compared in this study are: (control arm) permanent interstitial prostate brachytherapy (PIPB) VERSUS (experimental arm) intensity modulated external beam radiation therapy (IMRT).
Hypothesis:
The acute and late toxicities experienced by patients in the experimental arm (IMRT) are not significantly worse then the toxicities experienced by patients in the control arm (PIPB).
详细描述
Justification:
Patients with low risk and low-tier intermediate risk prostate cancer have a number of different standard treatment options to chose from that include a radical prostatectomy, conventional external beam radiotherapy (EBRT), or permanent interstitial prostate brachytherapy (PIPB). Each of these treatment options have good outcomes, although they are known to have a small risk of complications associated with each of them. Unfortunately, these treatment options have never been directly compared and therefore it is difficult to determine how these treatment options compare with respect to overall outcomes and toxicity.
A recent analysis from the BC Cancer Agency suggested that patients treated with conventional EBRT within the Agency had inferior outcomes compared to PIPB. This data, as well as other indirect evidence, suggest that conventional EBRT may be a suboptimal treatment option compared to PIPB. Intensity modulated external beam radiotherapy (IMRT) is a new technology that allows for the delivery of high doses of radiation that tightly conforms to the target and limits the dose to surrounding critical structures. Although IMRT is currently a standard therapeutic option that is utilized in other cancer sites at the BC Cancer Agency, it has not been utilized in prostate cancer yet. Recent evidence has confirmed that this experimental therapy is able to allow for the safe escalation of dose for prostate cancer patients, which may lead to improved outcomes, without increasing toxicity. There is no current evidence that side effects and complication risks associated with IMRT are associated with any serious risk of increased toxicity, although this continues to be studied.
This study will compare this new therapeutic approach (IMRT) directly with a standard treatment option for prostate cancer patients (PIPB). This trial will allow us to determine how the toxicities of these treatments compare with each other and, if successful, will potentially lead to a larger study which will analyse how the outcomes of these therapeutic interventions compare. We hope that this trial will make an important contribution to the care and future management of patients with prostate cancer.
Objectives:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 性别
- Male
- 接受健康志愿者
- 否
入选标准
- •Patients must have histologically proven adenocarcinoma of the prostate.
- •Registration must occur within 20 weeks of biopsy.
- •History and physical examination within 8 weeks prior to randomization.
- •Patients must have either low risk or low-tier intermediate risk prostate cancer (Low risk must have all of: clinical stage <= T2b, Gleason score <= 6, and initial PSA <= 10; Low-tier intermediate risk must have: clinical stage <= T2c, < 50% positive biopsy cores, AND EITHER Gleason score = 7 and initial PSA <= 10 OR Gleason score <= 6 and initial PSA > 10 and <= 15.)
- •Patients must have a ECG, PSA, TTT, CBC, electrolytes, Cr, INR, PTT, and random glucose within 2 weeks of registration.
- •Patients must be fit for general or spinal anesthetic.
- •Patients must have an estimated life expectancy of at least 10 years.
- •Patients must have an ECOG performance status of 0 -
- •Patients must have no contraindications for high dose pelvic irradiation or transperineal interstitial brachytherapy.
- •Patients must not have received prior radiation therapy to the pelvis.
- •Patients must have no history of inflammatory bowel disease.
- •Patients must not have received prior hormonal therapy or chemotherapy.
- •Patients must not have any hormonal therapy planned as part of the therapeutic intervention.
- •Patients must have prostate volumes < 60 cm3 on transrectal ultrasound.
- •Patients must not have received prior surgical treatment for prostate cancer including TURP, TURB, cryotherapy, laser ablation or microwave therapy.
- •Patients on coumadin therapy must be able to stop therapy safely for at least 12 days.
- •Patients must have an International Prostate Symptom Score (IPSS) of less than
- •Patients must have no history of previous malignancies, except non-melanoma skin tumors.
- •Patients must have a body mass index (BMI) of <= 32.
排除标准
- •Those patients who do not meet the inclusion criteria described above will be excluded from participation.
研究组 & 干预措施
Permanent interstitial prostate brachytherapy (PIPB)
patient will undergo permanent interstitial prostate brachytherapy (PIPB) using a transperineal approach to deliver 125Iodine Rapidstrand® seeds at the facilities of the British Columbia Cancer Agency (BCCA) by one or more of the certified prostate brachytherapists in the BCCA Prostate Brachytherapy Program. The minimum peripheral dose (MPD) to the prostate gland of the implant will be 144 Gy as per TG 43 protocol. A modified peripheral loading technique will be utilized in an effort to maintain the periurethral dose to < 150% of the MPD. Within 48 hours of the implant, the patient will undergo a day 0 CT scan of the pelvis to assess post implant dosimetry using the standard BCCA protocol.
干预措施: Intensity Modulated External Beam Radiation Therapy (Procedure)
Intensity modulated external beam radiation therapy (IMRT)
patient will undergo a course of intensity modulated external beam radiation therapy (IMRT) to a volume encompassing the prostate gland. The total radiation dose will be 70 Gy delivered in 28 fractions, so that the minimum dose to the PTV is 70 Gy, with CT simulation used for planning the treatment. Prior to starting the course of IMRT, fiducial markers will be placed in the prostate to assist in localization of the prostate for planning and quality assurance during treatment.
干预措施: Intensity Modulated External Beam Radiation Therapy (Procedure)
结局指标
主要结局
The primary end point of this study is the acute and late toxicities of the therapeutic interventions.
时间窗: Through study completion. Approximately 5 years.
次要结局
- Obstacles to accrual that need to be addressed.(1 year)
- Testing our ability to meet accrual targets.(1 year)
- The willingness of eligible patients to be randomized to the treatment interventions.(1 year)
- Checking quality assurance benchmarks for IMRT and PIPB procedures.(1 year)
- Quality of life based on urinary function, bowel habits, sexual function, and hormonal function(Assessed at 6 weeks, 6, 9, 12, 18, 24 ,30, 36 months. Then annually until end of participation)
- Pathological local control.(Assessed at 28 months)
- Metastasis-free survival.(Assessed at every clinic visit until end of participation. Approximately 10 years.)
- Biochemical relapse-free survival.(Assessed at every clinic visit and every 6 months)
- Overall survival.(Assessed at every clinic visit until end of participation. Approximately 10 years.)
研究者
James Morris
Radiation Oncologist
British Columbia Cancer Agency