Advanced Molecular Imaging With Anti-3-[18F]FACBC PET-CT to Improve the Selection and Outcomes of Prostate Cancer Patients Receiving Post-prostatectomy Radiotherapy
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 入组人数
- 165
- 试验地点
- 1
- 主要终点
- Failure-free Survival
研究概览
简要总结
Investigators will perform a study with 162 patients in whom there is a strong suspicion of prostate cancer that has returned to the body after having a prostatectomy. Half of these patients will have radiotherapy decision-making and delivery per the usual routine, and half of these patients will have the radiotherapy decision and volumes guided by the FACBC test (anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid (anti-3- [18F]FACBC). The major goal of the investigation is to see whether the FACBC improves the selection and the cancer control rates of post-surgery patients with a rising PSA who undergo radiotherapy.
详细描述
Prostate cancer is the most common solid tumor, with approximately 200,000 new cases diagnosed per year. Several different local therapies are available for treatment, including surgery and radiotherapy Significant advances have been made in the technical aspects of surgery and of radiotherapy which have improved both the cancer control outcomes as well as the morbidity of treatment. Despite these significant advances, approximately 30% of patients treated with definitive local therapy experience recurrent disease. Recurrent disease after prostatectomy usually manifests with rising PSA (blood test for prostate cancer). The PSA level is often of limited use in differentiating local recurrence (ie. recurrence in the prostate bed) from recurrence outside of the prostate bed ( extra-prostatic recurrence).
One PET radiotracer which has shown promise in the staging and restaging of patients with prostate carcinoma is anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid (anti-3-[18F]FACBC) which is a synthetic amino acid analog. FACBC demonstrated higher accuracy compared with 111Indium-capromab-pendetide in the restaging of patients with suspected recurrent prostate carcinoma.
The major goal in this proposed investigation is to use advanced molecular imaging to better guide post-prostatectomy decision making, in terms of guiding the decision to deliver radiotherapy, and in terms of the exact areas treated with radiotherapy.
Investigators will perform a study with 162 patients in whom there is a strong suspicion of prostate cancer that has returned to the body after having a prostatectomy. Half of these patients will have radiotherapy decision-making and delivery per the usual routine, and half of these patients will have the radiotherapy decision and volumes guided by the FACBC test. The major goal of the investigation is to see whether the FACBC improves the selection and the cancer control rates of post-surgery patients with a rising PSA who undergo radiotherapy.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 95 Years（Adult, Older Adult）
- 性别
- Male
- 接受健康志愿者
- 否
入选标准
- •Adenocarcinoma of the prostate, post radical-prostatectomy Detectable PSA
- •ECOG/Zubrod Performance Status of 0-2
- •Negative technetium 99-m MDP or F-18 PET bone scan for skeletal metastasis
- •CT or MR scan of abdomen and pelvis which does not suggest presence of metastatic disease outside of the pelvis
- •Willingness to undergo pelvic radiotherapy.
排除标准
- •Contraindications to radiotherapy (including active inflammatory bowel disease or prior pelvic XRT)
- •Inability to undergo anti-3-[18F]FACBC PET-CT
- •Age under 18
- •Metastatic disease outside of pelvis on any imaging or biopsy
- •Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years
- •Severe acute co-morbidity, defined as follows:
- •Unstable angina and/or congestive heart failure requiring hospitalization in the last 3 months
- •Transmural myocardial infarction within the last 6 months
- •Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
- •Chronic Obstructive Pulmonary Disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of registration
- •Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC definition; note, however, that HIV testing is not required for entry into this protocol. The need to exclude patients with AIDS from this protocol is necessary because the treatments involved in this protocol may be significantly immunosuppressive. Protocol-specific requirements may also exclude immunocompromised patients
研究组 & 干预措施
FACBC PET scan
A trial group in which anti-3-[18F]FACBC PET-CT is used to guide radiotherapy decisions and radiotherapy treatment volumes.
干预措施: FACBC (Drug)
Conventional-Only Imaging
A control group whose treatment decisions will be made based on conventional imaging - bone scan and abdominopelvic CT and/or MR scan.
干预措施: Radiation therapy (Radiation)
结局指标
主要结局
Failure-free Survival
时间窗: 3-Year post-intervention
Definition of failure is: serum PSA value of 0.2ng/mL or more above the postradiotherapy nadir followed by another higher value, a continued rise in the serum PSA despite radiotherapy (RT), initiation of systemic therapy after completion of RT, or clinical progression.
次要结局
- Total Number of Decision Changes(Average of 1 week post-intervention)
- Bladder Dosimetric Endpoints(Average of 1 month post-intervention)
- Decision Changes Regarding Whole-pelvis Versus Local Fields(Average of 1 week post-intervention)
- PTV Dosimetric Endpoints(Average of 1 month post-intervention)
- Expanded Prostate Cancer Index Composite (EPIC) Sexual Domain Score(3-Year post-intervention)
- Decision Changes Regarding Radiotherapy Versus no Radiotherapy(Average of 1 week post-intervention)
- Prostate Bed Clinical Target Volume (CTV)(Average of 1 month post-intervention)
- Prostate Bed Planning Target Volume (PTV)(Average of 1 month post-intervention)
- Expanded Prostate Cancer Index Composite (EPIC) GI (Gastrointestinal) Domain Score(3-Year post-intervention)
- Rate of ≥ Grade 2 GU (Genitourinary [Renal or Urinary]) Toxicity(3-Year post-intervention)
- Rate of ≥ Grade 2 GI (Gastrointestinal) Toxicity(3-Year post-intervention)
- Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC) GU (Genitourinary) Domain Score(3-Year post-intervention)
- Expanded Prostate Cancer Index Composite (EPIC) Total Score(3-Year post-intervention)
- Rectum Dosimetric Endpoints(Average of 1 month post-intervention)
研究者
Ashesh B Jani
Professor & Residency Program Director
Emory University