A Phase I Hypofractionation Trial of Re-irradiation in Good Prognosis Recurrent Glioblastoma
试验速览
- 阶段
- 1 期
- 状态
- 招募中
- 入组人数
- 28
- 试验地点
- 1
- 主要终点
- MTD of daily re-irradiation in participants with recurrent grade 4 gliomas
研究概览
简要总结
Background:
Glioblastoma (GBM) is a cancer of the brain. Current survival rates for people with GBM are poor; survival ranges from 5.2 months to 39 months. Most tumors come back within months or years after treatment, and when they do, they are worse: Overall survival drops to less than 10 months. No standard treatment exists for people whose GBM has returned after radiation therapy.
Objective:
To find a safe schedule for using radiation to treat GBM tumors that returned after initial radiation treatment.
Eligibility:
People aged 18 years and older with grade 4 GBM that returned after initial radiation treatment.
Design:
Participants will be screened. They will have a physical exam with blood tests. A sample of tumor tissue may be collected.
Participants will undergo re-irradiation planning: They will wear a plastic mask over their head during imaging scans. These scans will pinpoint the exact location of the tumor. This spot will be the target of the radiation treatments.
Participants will undergo radiation treatment 4 times per week. Some people will have this treatment for 3 weeks, some for 2 weeks, and some for 1 week. Blood tests and other exams will be repeated at each visit.
Participants will complete questionnaires about their physical and mental health. They will answer these questions before starting radiation treatment; once a week during treatment; and at intervals for up to 3 years after treatment ends.
Participants will have follow-up visits 1 month after treatment and then every 2 months for 6 months. Follow-up clinic visits will continue up to 3 years. Follow-ups by phone or email will continue an additional 2 years.
详细描述
Background:
- Although survival of glioblastoma (GBM) has improved using standard of care chemoradiation, outcomes are still poor. Most patients will recur within months to years, in or adjacent to their previous treatment field.
- There is no consensus standard of care for patients with recurrent GBM. Re-resection is recommended, if possible, to improve symptoms and decrease tumor volume. However, this treatment option is possible only in a minority of patients, and for these patients re-irradiation has emerged as a possible treatment.
- Modern radiation therapy (RT) techniques allow delivery of re-irradiation while minimizing the dose to previously treated organs at risk (OAR) within the radiation field.
- Data from a recently completed clinical trial at our center (16-C-0081, NCT02709226) suggests that the Maximum Tolerated Dose (MTD) of re-irradiation in 350 cGy fractions is 4200 cGy.
Objective:
-To determine the maximum tolerated dosage of daily re-irradiation in participants with recurrent Grade 4 gliomas
Eligibility:
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Sequential
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 120 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •INCLUSION CRITERIA:
- •Histologic diagnosis of primary glioblastoma or gliosarcoma of the brain, or secondary glioblastoma of the brain due to transformation from a lower grade to a grade 4 tumor.
- •KPS >= 70%.
- •Previous tumor irradiation to curative-intent doses.
- •Radiation dose constraints must be achievable based on assessment with MRI and treatment planning CT.
- •Participants must have adequate organ and marrow function as defined below:
- •Absolute neutrophil count (ANC) >= 1,000/microL
- •Platelets >= 100,000/microL
- •Individuals of child-bearing potential (IOCBP) and individuals who can father children must agree to use effective contraception (barrier, hormonal, intrauterine device, surgical sterilization, abstinence) from study entry and through 6 months after the last study treatment (restricted period). Individuals who can father children must not freeze or donate sperm within the same period.
- •Nursing participants must be willing to discontinue nursing from study treatment initiation through 6 months after the last study treatment.
- •The ability of a participant to understand and the willingness to sign a written informed consent document.
排除标准
- •Recent systemic therapy prior to the initiation of the study therapy as follows:
- •Bevacizumab used for reasons other than tumor progression or symptomatic management within 2 weeks.
- •Temozolomide within 2 weeks.
- •Cytotoxic chemotherapy within 3 weeks.
- •Any investigational agents within 2 weeks.
- •Participants who are unable to undergo MRI evaluation or receive gadolinium contrast for any reason.
- •Any prior therapy after surgical re-resection or biopsy within 2 weeks prior to the initiation of the study therapy.
- •Requiring radiation therapy within 12 months prior to the initiation of study therapy.
- •History of prior therapy with Novacure TTF, Gliadel wafers, or GammaTile therapy.
- •Positive beta-human chorionic gonadotropin (HCG) pregnancy test performed in individuals of childbearing potential at screening.
- •Participants with known or suspected radiation sensitivity syndromes.
- •Uncontrolled intercurrent illness evaluated by medical history and physical exam that are not stable and would potentially increase the risk to the participant.
研究组 & 干预措施
1/Arm 1
Fraction size escalation of 3 planned re-irradiation dose levels.
干预措施: Radiation Therapy (Radiation)
2/Arm 2
MTD of re-irradiation dose.
干预措施: Radiation Therapy (Radiation)
结局指标
主要结局
MTD of daily re-irradiation in participants with recurrent grade 4 gliomas
时间窗: DLT period (28 days)
The number of participants experiencing DLTs within the DLT period will be reported for each hypofractionation schema. The MTD will be identified, and the proportion of participants treated with the MTD experiencing DLT will be reported.
次要结局
- Longitudinally describe and evaluate disease and treatment-related symptom severity and interference with daily activities(Baseline through 3 years post radiation therapy.)
- Meaningful change in disease and treatment-related symptoms by using anchors(Baseline through 3 years post radiation therapy.)
- Progression free survival(Baseline, 30 day safety follow up visit, every 2 months for 2 years, every 3 months for 3rd year, or until progression)
- Overall survival(Treatment and follow up)
- Compliance and feasibility of administering PRO in this participant population(Baseline through 3 years post radiation therapy.)
- Tolerability of treatment by assessing adverse events, cognitive function, physical function, and side effect bother(First radiation treatment administration through 6 months after the last day of radiation. Beyond 6 months after radiation, only adverse events which are serious and related to radiation need to be recorded.)