A Phase 1 Study of Stereotactic Body Radiotherapy (SBRT) for the Treatment of Multiple Metastases
Overview
- Phase
- Phase 1
- Intervention
- Not specified
- Conditions
- Male Breast Carcinoma
- Sponsor
- NRG Oncology
- Enrollment
- 42
- Locations
- 78
- Primary Endpoint
- Dose-limiting toxicity (DLT) scored according to the National Cancer Institute (NCI) CTCAE version 4.0 for each of 7 metastatic locations when multiple metastases are treated with SBRT
- Status
- Completed
- Last Updated
- 3 years ago
Overview
Brief Summary
This phase I trial studies the side effects and the best dose of stereotactic body radiation therapy in treating patients with breast cancer, non-small cell lung cancer, or prostate cancer that has spread to other parts of the body. Stereotactic body radiation therapy delivers fewer, tightly-focused, high doses of radiation therapy to all known sites of cancer in the body while minimizing radiation exposure of surrounding normal tissue.
Detailed Description
PRIMARY OBJECTIVES: I. To determine the recommended stereotactic body radiation therapy (SBRT) dose for each of the metastatic locations being treated given the individual and overlapping fields when multiple metastases are treated with SBRT in a national clinical trials network setting. SECONDARY OBJECTIVES: I. To estimate rates of \>= grade 3 Common Terminology Criteria for Adverse Events (CTCAE), version (v.) 4.0 adverse events other than a dose-limiting toxicity (DLT) which is possibly, probably, or definitely related to treatment and which occurs within 6 months from the start of SBRT to multiple metastases. II. To estimate the rates of long-term adverse events occurring up to 2 years from the end of SBRT. III. To explore the most appropriate and clinically relevant technological parameters to ensure quality and effectiveness throughout radiation therapy processes, including imaging, simulation, patient immobilization, target and critical structure definition, treatment planning, image guidance and delivery. OUTLINE: Patients undergo 3-5 fractions of image-guided stereotactic body radiation therapy to all existing metastases over 1-3 weeks with at least 40 hours between treatments for an individual metastasis. After completion of study treatment, patients are followed up at 35-45 days and then every 3 months for 2 years.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Metastatic breast cancer (MBC) OR metastatic non-small cell lung cancer (NSCLC) OR metastatic adenocarcinoma of the prostate; the sites of allowed metastases are: peripheral lung, central lung, mediastinal/cervical lymph node, liver, spinal/paraspinal, osseous, and abdominal-pelvic
- •NOTE: after the required number of evaluable patients have been accrued for a given dose level, the accrual for that metastatic location will be temporarily suspended while the safety of that dose level is assessed; a patient can only be entered onto the trial if all of their metastatic locations are open to accrual (e.g. if central lung is temporarily suspended for safety assessment and the patient has a central lung metastases, regardless of other metastases, they cannot enroll until the safety of dose to central lung is determined)
- •Primary tumor site without progression at registration
- •All metastases not resected must be amenable to SBRT
- •The patient must meet ONE of the three following criteria:
- •3-4 radiographically distinct metastases of any distribution in the allowed anatomical sites OR
- •2 radiographically distinct metastases that must be anatomically close (i.e., with less than or equal to 5 cm of normal tissue between them) OR
- •3 or 4 distinct metastasis, 2 or 3 to be treated with SBRT and the other (s) having been surgically removed
- •Evaluation by a radiation oncologist within 45 days prior to study registration
- •Evaluation by a medical oncologist within 45 days prior to study registration
Exclusion Criteria
- •Progression of primary tumor site (breast, prostate, or lung) at time of registration
- •Metastases with indistinct borders making targeting not feasible
- •Known brain metastases
- •Prior palliative radiotherapy to metastases
- •Metastases located within 3 cm of the previously irradiated structures:
- •Spinal cord previously irradiated to \> 40 Gy (delivered in =\< 3 Gy/fraction)
- •Brachial plexus previously irradiated to \> 50 Gy (delivered in =\< 3 Gy/fraction)
- •Small intestine, large intestine, or stomach previously irradiated to \> 45 Gy (delivered in =\< 3 Gy/fraction)
- •Brain stem previously irradiated to \> 50 Gy (delivered in =\< 3 Gy/fraction)
- •Whole lung previously irradiated with prior volume 20 Gy (V20Gy) \> 30% (delivered in =\< 3 Gy/fraction)
Outcomes
Primary Outcomes
Dose-limiting toxicity (DLT) scored according to the National Cancer Institute (NCI) CTCAE version 4.0 for each of 7 metastatic locations when multiple metastases are treated with SBRT
Time Frame: Within 6 months from the start of treatment; for each of the 7 metastatic locations, analysis occurs after 6 evaluable patients have been followed for a minimum of 6 months from the start of treatment
Adverse events outlined by metastatic location (full detail in protocol) reported as being probably or definitely related to protocol treatment.
Secondary Outcomes
- Rates of >= grade 3 adverse events, scored according to NCI CTCAE v. 4.0(Within 6 months from the start of treatment; analysis occurs after all patients have been followed for a minimum of 6 months from the start of treatment)
- Rate of long-term adverse events, scored according to the NCI CTCAE v. 4.0(Up to 2 years from end of treatment; analysis occurs after all patients have been potentially followed for 2 years from registration)