Internal Radiation Therapy for Hepatocellular Carcinomas With Therasphere: Optimized Dosimetry Versus Standard Dosimetry

Phase 2

Completed

Interventions: Radiation: Standard Internal Radiation Therapy
Radiation: Optimized Internal Radiation Therapy

Brief Summary: The purpose of this study is to determine whether a treatment with Therasphere which is optimized is more efficient compared to a standard treatment for patients suffering from hepatocellular carcinomas.

Detailed Description: For patients suffering from hepatocellular carcinoma, a palliative treatment can be proposed if tumor expansion is limited to the liver. One of palliative treatment is the the Selective Internal Radiation Therapy (SIRT) with Therasphere®. This treatment is made secure by performing a diagnostic angiogram coupled with a hepatic perfusion scintigraph with which patients at risk of complications are identified and excluded. The treatment objective, with the standard dosimetric approach, is to deliver an absorbed dose of 120 ± 20 Gy to the treated hepatic volume, most often one lobe. Recent retrospective trials show that an optimized dosimetric approach, considering the dose absorbed by the tumor, is technically achievable and would probably make it possible to obtain a better effectiveness. In our experience, treatment personalisation have been described to be used for 60% of the patients with a tumor larger than 7 cm underlying the clinical impact of this new approach.

Recruitment & Eligibility

Inclusion Criteria

Age ≥ 18,
Written free and informed consent,
Histologically demonstrated Hepatocellular Carcinoma (HCC), not a candidate for surgery or local ablative treatment (radio frequency, etc.)
Barcelona Clinic Liver Cancer (BCLC) classification A, B or C,
At least one lesion ≥ 7 cm,
Hepatic reserve (hepatic parenchyma not treated) after the first SIRT ≥ 30%,
Unilateral involvement, minimal bilateral involvement allowed only with a hepatic reserve ≥ 30% after SIRT
Child A classification only, or B but with bilirubinemia <35 micromol/L,
Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1,
Patients whose biological parameters meet the following criteria:
- Hemoglobin ≥ 8.5 g/dL,
- Granulocytes ≥ 1500/mm3,
- Platelets ≥ 50,000/mm3,
- Bilirubinemia <35 micromol per liter,
- Transaminases ≤ five times the upper limit of normal,
- Creatininemia ≤ 1.5 times the normal upper limit,
Expected survival over 12 weeks,
Negative pregnancy test for women of childbearing age,
If sorafenib has been taken the diagnostic angiogram must follow it by at least four weeks after its stop.

Exclusion Criteria

HCC operable or accessible to a local ablative treatment (radio frequency),
Hepatectomy history unless a segmental treatment is considered, with a hepatic reserve ≥ 30% after SIRT,
Prior treatment with sorafenib unless stopped at least four weeks earlier,
History of chemo-embolization of the principal lesion, except in case of nodular residual lesion measuring at least 7 cm or in case of progression after initial response,
Bilateral disease requiring a whole liver injection or with a hepatic reserve < 30% after SIRT
Treatment of another cancer less than one year earlier,
Extra-hepatic metastases other than adenopathies of the hilum smaller than 2 cm,
>70% tumor invasion of the liver,
Bilirubinemia ≥ 35 µmol/L,
A Severe underlying biliary pathology:
Bile duct anomaly (stent, dilation) Cirrhosis of biliary origin,
Women of childbearing age without contraception
Pregnant or nursing women

Arm && Interventions

Group	Intervention	Description
Standard dosimetry	Standard Internal Radiation Therapy	Standard Internal Radiation Therapy : Dose of radiation delivered to the tumoral volume is fixed : 120 Gray (GY)
Optimized dosimetry	Optimized Internal Radiation Therapy	Optimized Internal Radiation Therapy : Dose of radiation absorbed by the tumor is \> 205 GY, if possible 250 or 300 Gy.

Primary Outcome Measures

Name	Time	Method
The primary endpoint is to compare the response rate of the treated lesion at the first radioembolization, evaluated using European Association for the Study of the Liver (EASL) criteria of yttrium-90 marked glass microspheres SIRT	3 months after treatment administration

Secondary Outcome Measures

Name	Time	Method
Progression Free Survival	Up to 12 months
Overall survival	Up to 30 months after inclusion of the 1st patient
Related Adverse Events in both arms as assessed by National Cancer Institute criteria (National Cancer Institute Common Terminology Criteria for Adverse Events, (NCI CTCAE) version 4).	Up to 12 months
Progression free survival not accessible to SIRT	Up to 12 months after treatment administration
Post-therapeutic dosimetry measured by Positron emission tomography-computed tomography PET / CT	Day one of treatment administration	Dose delivered to the treated liver, the tumors, healthy liver and lings

Locations (4): CHU Saint Eloi
🇫🇷
Montpellier, France
Centre Eugène Marquis
🇫🇷
Rennes, France
Gustave Roussy
🇫🇷
Villejuif, France
CHU Henri Mondor
🇫🇷
Créteil, France