Feasibility of High Dose PROton Therapy On Unresectable Primary Carcinoma Of Liver: Prospective Phase II Trial
试验速览
- 阶段
- 2 期
- 入组人数
- 66
- 试验地点
- 2
- 主要终点
- two-year overall survival
研究概览
简要总结
The standard treatment of unresectable hepatocellular carcinoma (HCC) is transarterial chemoembolization (TACE) or sorafenib. Though the TACE and the agent showed survival benefit in several randomized phase III trials, the benefit was modest.
Recently, radiotherapy (RT), especially conformal and higher dose with the advancement of RT techniques, showed favorable response rate with acceptable local control rate. Based on those promising results, RT was actively applied in HCC who are not indicated with surgery and/or radiofrequency ablation.
Many researchers reported that there is a relationship between RT dose and tumor response rate. RT dose, however, is frequently limited because the complications (like radiation induced liver disease (RILD), radiation induced gastro-duodenal toxicity, etc.) are also closely related with higher exposed RT dose.
Proton beam has characteristic depth-dose distribution contrast to photon, the "Bragg peak". The advantage of this dose distribution could be more highlighted in HCC management, because of the weakness and maintenance importance of liver function itself in HCC patients. In fact, the superior results of proton beam therapy in HCC were constantly reported in several groups as prospectively as well as retrospectively.
In this background, the investigators planned the present study to evaluate the efficacy and safety of proton beam therapy in HCC patients who are not indicated with surgery and/or radiofrequency ablation (RFA).
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 20 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Hepatocellular carcinoma (HCC) patients (Pathologically proven or HCC diagnosed based on American Association for the Study of Liver Diseases (AASLD) guideline)
- •Not indicated with surgical resection and/or RFA
- •Discussion in tumor board including gastroenterologist, radiologist, radiation oncologist
- •Eastern Cooperative Oncology Group performance status 0 to 2 within 1 week before participate
- •Adequate bone marrow function (absolute neutrophil count ≥ 1.0 x 109/l, platelet ≥ 30 x 109/l, hemoglobin ≥ 8 g/dl)
- •Adequate liver/renal function within 1 week before participate
- •Total bilirubin <3.0 mg/dL, Prothrombin time/International normalized ratio <1.7, Albumin≥2.8g/dL, Aspartate aminotransferase/alanine aminotransferase<6 times of upper normal limit Serum creatinine < 1.5 x upper normal limit, glomerular filtration rate > 50 ml/min
- •Informed consent
- •If viable tumor is single, 1 cm to 10 cm
- •Less than 3 nodules
- •Child-Pugh class A, B, or early C (score ≤ 10)
- •Women of childbearing potential and male participants must agree to practice adequate contraception while on study and for at least 6 months following the last dose of RT
排除标准
- •Uncontrolled hepatic encephalopathy
- •Previous history of upper abdominal radiotherapy
- •Status of pregnancy or breast feeding
- •Less than 12 weeks of expected survival
- •Uncontrolled ascites
- •Combined with disease known as radiosensitive disorder (connective tissue disorder, Ataxia-telangiectasia)
- •Hard to maintain stable respiration less than 5 minutes related with respiratory disease
- •Combined with uncontrolled severe acute disease other than liver
研究组 & 干预措施
Proton arm
Proton beam therapy
干预措施: Proton arm (Radiation)
结局指标
主要结局
two-year overall survival
时间窗: two-year after proton beam therapy
次要结局
- 1 month objective response rate(1 month after proton beam therapy)
- 3 month objective response rate(3 months after proton beam therapy)
- Baseline Quality of life assessment by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ C-30)(Within 2 week before proton beam therapy started)
- 1 month Quality of life assessment by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ C-30) compared with baseline(1 month after proton beam therapy)
- 3 month Quality of life assessment by EORTC QLQ C-30 compared with baseline(3 month after proton beam therapy)
- 6 month Quality of life assessment by EORTC QLQ C-30 compared with baseline(6 month after proton beam therapy)
- Baseline Indocyanine green (ICG)(Within 2 week before proton beam therapy started)
- Indocyanine green (ICG) test change compared with baseline(3 month after proton beam therapy)
- Baseline hepatobiliary phase signal(Within 2 week before proton beam therapy started)
- Hepatobiliary phase signal change after proton beam therapy(3 month after proton beam therapy)
- 6 month objective response rate(6 months after proton beam therapy)
- 1 year progression free survival(one-year after proton beam therapy)
- 1 year local progression free survival(one-year after proton beam therapy)
- 6 months adverse event(6 months after proton beam therapy)
- 1 year adverse event(1 year after proton beam therapy)
研究者
Joon-Hyeok Lee
Professor
Samsung Medical Center