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Individualized Stereotactic Body Radiotherapy of Liver Metastases

Primary Purpose

Solid Tumor, Liver Metastases

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Stereotactic body radiotherapy-proton
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Solid Tumor focused on measuring proton radiation, stereotactic body radiotherapy, SBRT

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Biopsy-proven cancer diagnosis of a solid tumor with 1-4 liver metastases. There is no upper size limit. Liver metastases may be diagnosed by imaging alone, no liver biopsy is required. Extrahepatic disease is allowed if it have been stable for 3 months prior to study entry, the dominant disease burden is intrahepatic and the patient is referred for definitive radiation therapy to the disease in the liver
  • Measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension as 10mm or greater with spiral CT scan
  • Patients may have had prior chemotherapy, targeted biological therapy, surgery, transarterial chemoembolization (TACE), radiofrequency ablation, or cryosurgery for their disease as long as the prior therapy occured greater than 3 weeks elapsed before the first radiation treatment. Patients may not have had prior liver directed radiation, including radioembolization.
  • 18 years of age or older
  • Expected survival must be greater than three months
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2
  • Patients must have at least 800mL of uninvolved liver
  • Normal organ and marrow function as outlined in the protocol
  • If patient has underlying cirrhosis, only Child-Pugh classification Group A patients should be included in this study. Clinical assessment of ascites and encephalopathy is required. Child-Pugh classification must be determined for all study participants at the time of eligibility analysis.
  • Women of child-bearing potential and men must agree to use adequate contraception prior to study entry and for the duration of study participation

Exclusion Criteria:

  • Women who are pregnant or lactating
  • Patients with gross ascites or encephalopathy
  • Local conditions or systemic illnesses which would reduce the local tolerance to radiation treatment, such as serious local injuries, active collagen vascular disease, etc.
  • Prior liver directed radiation treatment, including selective internal radiation
  • No serious medical illness, which may limit survival to less than 3 months
  • No serious psychiatric illness which would limit compliance with treatment
  • Participants who have had chemotherapy or radiotherapy within 3 weeks prior to starting study treatment or those who have not recovered from adverse events due to agents administered more than 3 weeks earlier
  • Participants may not be receiving any other investigational agents, or any other anti-cancer therapy during treatment
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia.
  • Only solid tumors are permitted. Thus, individuals with a liver mass from a diagnosis of lymphoma or leukemia are excluded

Sites / Locations

  • Massachusetts General Hospital
  • Dana-Farber Cancer Institue

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

SBRT-Proton

Arm Description

Stereotactic body radiotherapy by proton radiation

Outcomes

Primary Outcome Measures

Local Control Rate
The percentage of participants with local control at primary tumor site at one year. Local is evaluated using Response Evaluation Criteria In Solid Tumors (RECIST). Local control is defined as achieving either Complete response (CR), Partial Response (PR), or Stable Disease (SD). (CR): Disappearance of entire lesion, with no additional evidence of disease. (PR): At least a 30% decrease in the (sum of) the longest diameter (LD) of the primary lesion, taken as reference the baseline sum LD. (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started.

Secondary Outcome Measures

Median Follow-up Time
The median follow-up time among the 39 participants still alive at the time of analysis, measured from the start of treatment until the time of analysis.
Median Overall Survival
The median overall survival (in months) of participants as measured from the start of treatment.
Median Progression Free Survival
The median amount of time participants survived without cancer progression following the start of study treatment. Progression was assessed using RECIST v1.0. Progressive Disease (PD) is defined as at least a 20% increase in the Longest Diameter (LD) of the lesion, taken as the reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions.
2-year Local Control Rate
The percentage of participants with local control 2 years after the start of study treatment.
1 Year Local Control Rate Among Participants With Colorectal Cancer
The percentage of participants with local control at one year among the participants with colorectal cancer as the primary cancer.
Median Survival Among Participants With Colorectal Cancer
The median amount of time participants survived from the start of treatment, among the participants with colorectal cancer.

Full Information

First Posted
June 14, 2010
Last Updated
October 3, 2017
Sponsor
Massachusetts General Hospital
Collaborators
Dana-Farber Cancer Institute, Brigham and Women's Hospital, National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT01239381
Brief Title
Individualized Stereotactic Body Radiotherapy of Liver Metastases
Official Title
Phase II Study of Individualized Stereotactic Body Radiotherapy of Liver Metastases
Study Type
Interventional

2. Study Status

Record Verification Date
October 2017
Overall Recruitment Status
Completed
Study Start Date
June 2010 (undefined)
Primary Completion Date
January 2016 (Actual)
Study Completion Date
September 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital
Collaborators
Dana-Farber Cancer Institute, Brigham and Women's Hospital, National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Stereotactic body radiation therapy (SBRT) is a technique that is used to deliver radiation, to sites in the body. All participants in this study will be treated with SBRT using proton beam radiation. Proton beam radiation uses tiny particles to deliver radiation to tumors. The purpose of this research study is to determine if SBRT with protons will prevent tumor growth and reduce the treatment side effects for liver metastases.
Detailed Description
Participants receiving SBRT with protons, will receive radiation treatment as an outpatient at the Francis H. Burr Proton Therapy Center at Massachusetts General Hospital. Not everyone who participates in this study will be receiving the same dose of radiation. The dose received will be determined by the size and location of the tumor(s). Participants will receive 2-3 SBRT treatments per week for two weeks. During radiation therapy visits the following tests/procedures will be performed: vital signs, physical examination, routine blood tests, research blood tests, and radiation planning. Follow-up assessments will be performed once at 9 weeks after study treatment, then at 6 months, 12 months, 18 months and 24 months after treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Solid Tumor, Liver Metastases
Keywords
proton radiation, stereotactic body radiotherapy, SBRT

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
92 (Actual)

8. Arms, Groups, and Interventions

Arm Title
SBRT-Proton
Arm Type
Experimental
Arm Description
Stereotactic body radiotherapy by proton radiation
Intervention Type
Radiation
Intervention Name(s)
Stereotactic body radiotherapy-proton
Intervention Description
Dose will be determined by the size and location of the tumor(s); 2-3 treatments per week for two weeks
Primary Outcome Measure Information:
Title
Local Control Rate
Description
The percentage of participants with local control at primary tumor site at one year. Local is evaluated using Response Evaluation Criteria In Solid Tumors (RECIST). Local control is defined as achieving either Complete response (CR), Partial Response (PR), or Stable Disease (SD). (CR): Disappearance of entire lesion, with no additional evidence of disease. (PR): At least a 30% decrease in the (sum of) the longest diameter (LD) of the primary lesion, taken as reference the baseline sum LD. (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started.
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Median Follow-up Time
Description
The median follow-up time among the 39 participants still alive at the time of analysis, measured from the start of treatment until the time of analysis.
Time Frame
1 year
Title
Median Overall Survival
Description
The median overall survival (in months) of participants as measured from the start of treatment.
Time Frame
2 years
Title
Median Progression Free Survival
Description
The median amount of time participants survived without cancer progression following the start of study treatment. Progression was assessed using RECIST v1.0. Progressive Disease (PD) is defined as at least a 20% increase in the Longest Diameter (LD) of the lesion, taken as the reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions.
Time Frame
1 years
Title
2-year Local Control Rate
Description
The percentage of participants with local control 2 years after the start of study treatment.
Time Frame
2 years
Title
1 Year Local Control Rate Among Participants With Colorectal Cancer
Description
The percentage of participants with local control at one year among the participants with colorectal cancer as the primary cancer.
Time Frame
1 year
Title
Median Survival Among Participants With Colorectal Cancer
Description
The median amount of time participants survived from the start of treatment, among the participants with colorectal cancer.
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Biopsy-proven cancer diagnosis of a solid tumor with 1-4 liver metastases. There is no upper size limit. Liver metastases may be diagnosed by imaging alone, no liver biopsy is required. Extrahepatic disease is allowed if it have been stable for 3 months prior to study entry, the dominant disease burden is intrahepatic and the patient is referred for definitive radiation therapy to the disease in the liver Measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension as 10mm or greater with spiral CT scan Patients may have had prior chemotherapy, targeted biological therapy, surgery, transarterial chemoembolization (TACE), radiofrequency ablation, or cryosurgery for their disease as long as the prior therapy occured greater than 3 weeks elapsed before the first radiation treatment. Patients may not have had prior liver directed radiation, including radioembolization. 18 years of age or older Expected survival must be greater than three months Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2 Patients must have at least 800mL of uninvolved liver Normal organ and marrow function as outlined in the protocol If patient has underlying cirrhosis, only Child-Pugh classification Group A patients should be included in this study. Clinical assessment of ascites and encephalopathy is required. Child-Pugh classification must be determined for all study participants at the time of eligibility analysis. Women of child-bearing potential and men must agree to use adequate contraception prior to study entry and for the duration of study participation Exclusion Criteria: Women who are pregnant or lactating Patients with gross ascites or encephalopathy Local conditions or systemic illnesses which would reduce the local tolerance to radiation treatment, such as serious local injuries, active collagen vascular disease, etc. Prior liver directed radiation treatment, including selective internal radiation No serious medical illness, which may limit survival to less than 3 months No serious psychiatric illness which would limit compliance with treatment Participants who have had chemotherapy or radiotherapy within 3 weeks prior to starting study treatment or those who have not recovered from adverse events due to agents administered more than 3 weeks earlier Participants may not be receiving any other investigational agents, or any other anti-cancer therapy during treatment Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia. Only solid tumors are permitted. Thus, individuals with a liver mass from a diagnosis of lymphoma or leukemia are excluded
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Theodore S. Hong, MD
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States
Facility Name
Dana-Farber Cancer Institue
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
28954285
Citation
Hong TS, Wo JY, Borger DR, Yeap BY, McDonnell EI, Willers H, Blaszkowsky LS, Kwak EL, Allen JN, Clark JW, Tanguturi S, Goyal L, Murphy JE, Wolfgang JA, Drapek LC, Arellano RS, Mamon HJ, Mullen JT, Tanabe KK, Ferrone CR, Ryan DP, Iafrate AJ, DeLaney TF, Zhu AX. Phase II Study of Proton-Based Stereotactic Body Radiation Therapy for Liver Metastases: Importance of Tumor Genotype. J Natl Cancer Inst. 2017 Sep 1;109(9). doi: 10.1093/jnci/djx031.
Results Reference
derived

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Individualized Stereotactic Body Radiotherapy of Liver Metastases

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