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SBRT Pre-operatively for Pancreatic Cancer (SPARC)

Primary Purpose

Pancreatic Neoplasms

Status
Completed
Phase
Phase 1
Locations
United Kingdom
Study Type
Interventional
Intervention
5-fraction stereotactic body radiation therapy
Sponsored by
University of Oxford
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pancreatic Neoplasms focused on measuring Borderline resectable

Eligibility Criteria

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

Inclusion Criteria:

  1. Borderline resectable localised tumour of the pancreatic head/uncinate process/body as per NCCN Guidelines (tumours of the tail of pancreas are not eligible for inclusion) or operable tumour in contact with vein (SMV or PV) not causing distortion or narrowing as defined by CT +/- MRI +/- PET criteria within 28+/- 7 days prior to trial entry de novo or following chemotherapy.
  2. Histologically proven pancreatic ductal adenocarcinoma or cytological proven pancreatic malignancy.
  3. Able to undergo biliary drainage using a stent.
  4. Deemed fit and suitable for surgical resection.
  5. No overt metastases or uncertain status with investigations suspicious of possible metastatic disease (e.g. small equivocal pulmonary nodule(s)).
  6. Male or female, Age >= 16 years.
  7. Life expectancy of at least 6 months.
  8. ECOG performance status 0- 1
  9. The patient is willing and able to comply with the protocol for the duration of the study, and scheduled follow-up visits and examinations.
  10. Written (signed and dated) informed consent and be capable of co-operating with protocol.
  11. Haematological and biochemical indices within defined ranges.

Exclusion Criteria:

  1. Distant metastatic disease or local disease that cannot be encompassed in the SBRT field.
  2. History of previous or concurrent malignancy diagnoses for which the expected prognosis is likely to be worse than that for the current diagnosis of pancreatic cancer (excludes for example: e.g. localised prostate cancer, early colorectal cancer, early breast cancer, curatively-treated basal cell carcinoma of skin, carcinoma in situ of cervix; curatively treated cancer of other sites who are recurrence free for >3 years).
  3. Serious medical or psychological condition precluding trial intervention.
  4. Previous upper abdominal or right chest wall radiotherapy where 30% of the liver has received >15Gy.
  5. PPregnancy. Pregnant or breast-feeding women are ineligible. Women of childbearing potential must use effective methods of contraception.
  6. Any other psychological, social or medical condition, physical examination finding or laboratory abnormality that the Investigator considers makes the patient a poor trial candidate or could interfere with protocol compliance or the interpretation of the trial results.

Sites / Locations

  • The Beatson West of Scotland Cancer Centre
  • St James' Hospital
  • Northern Centre for Cancer Care, The Freeman Hospital
  • City Hospital
  • The Churchill Hospital, Oxford University Hospitals Trust

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

5-fraction stereotactic body radiation therapy

Arm Description

See intervention

Outcomes

Primary Outcome Measures

Maximum tolerated dose (MTD)
The maximum tolerated dose (MTD) is defined as the highest dose of margin-intensive SBRT delivered pre-operatively at which no more than 1 of 6 patients or 0 of 3 patients experiences a dose limiting toxicity (DLT)

Secondary Outcome Measures

Definitive resection rate
R0/R1/R2 resection margin rates
Rate of pathological complete response
Any Late GI AE/other AE > grade 2 CTCAE v4.03
Overall survival and progression free survival at 12 and 24 months post D1 SBRT

Full Information

First Posted
December 2, 2014
Last Updated
September 29, 2021
Sponsor
University of Oxford
Collaborators
Oncology Clinical Trials Office, Centre for Statistics in Medicine, CRUK/MRC Oxford Institute for Radiation Oncology, University of Leeds
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1. Study Identification

Unique Protocol Identification Number
NCT02308722
Brief Title
SBRT Pre-operatively for Pancreatic Cancer
Acronym
SPARC
Official Title
A Phase I Trial of Pre-operative, Margin Intensive, Stereotactic Body Radiation Therapy for Pancreatic Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
April 2017
Overall Recruitment Status
Completed
Study Start Date
April 2015 (undefined)
Primary Completion Date
February 2019 (Actual)
Study Completion Date
February 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Oxford
Collaborators
Oncology Clinical Trials Office, Centre for Statistics in Medicine, CRUK/MRC Oxford Institute for Radiation Oncology, University of Leeds

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
In this study the investigators are testing if the addition of Stereotactic Body Radiation therapy (SBRT) prior to surgery improves surgical outcome in patients with borderline resectable or resectable pancreatic cancer (BRPC).
Detailed Description
This is a single arm prospective phase I dose escalation radiation study investigating 5-fraction stereotactic radiotherapy prior to planned surgical resection in borderline resectable or resectable pancreatic cancer. Surgical resection is the only potentially curative technique for managing pancreatic cancer. However more than 80% of patients present with disease that cannot be cured with surgical resection. Negative margin (R0 resection), tumour size, absence of lymph nodes metastases are the strongest prognostic indicators for long term survival. Stereotactic body radiation therapy (SBRT) is a radiation technique for pancreatic cancer where an ablative dose of radiotherapy (RT) can be delivered to a small volume targeting the at risk surgical margin in a short time (1 week versus 5-6 weeks for standard radiotherapy), achieving much higher biologically equivalent dose (BED) (100Gy versus 50Gy) than conventionally fractionated radical RT. The short time of delivery and minimal acute toxicity makes this an attractive treatment option in BPRC as offers the opportunity to integrate systemic treatment. With standard fractionation schedules larger volumes of normal tissue are usually irradiated than with SBRT and an effective dose is limited by toxicity despite the use of Intensity Modulated RT. This study builds on the current evidence base in SBRT pancreas, which has so far been largely used in the locally advanced setting with promising results and aims to take it a step further. This study aims to test the safety and benefit of pre-operative SBRT, delivering very high local doses to the at risk surgical margin which is usually around the main vessels in the retroperitoneum. The concept of margin-intensive therapy is novel, and aims to deliver a higher radiation dose while limiting toxicity to organs at risk.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pancreatic Neoplasms
Keywords
Borderline resectable

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Actual)

8. Arms, Groups, and Interventions

Arm Title
5-fraction stereotactic body radiation therapy
Arm Type
Experimental
Arm Description
See intervention
Intervention Type
Radiation
Intervention Name(s)
5-fraction stereotactic body radiation therapy
Intervention Description
The investigators expect to need a maximum of 3 dose levels investigating dose to the area at risk of involved resection lines and to the tumour bed to assess the tolerability of SBRT in this setting. Patient entry will commence at level 1. There is the option to de-escalate to Level -1 should 2 or more DLTs be observed at the starting level. SBRT will not be escalated above level 3. Level -1: Tumour (PTV) 6Gy/# (total dose 30Gy). Area at risk of R1 (PTV_R) 8Gy/# (total dose 40Gy) Level 1: Tumour (PTV) 6Gy/# (total dose 30Gy). Area at risk of R1 (PTV_R) 9Gy/# (total dose 45Gy) Level 2: Tumour (PTV) 6.5Gy/# (total dose 32.5Gy). Area at risk of R1 (PTV_R) 9.5Gy/# (total dose 47.5Gy) Level 3: Tumour (PTV) 7Gy/# (total dose 35Gy). Area at risk of R1 (PTV_R) 10Gy/# (total dose 50Gy)
Primary Outcome Measure Information:
Title
Maximum tolerated dose (MTD)
Description
The maximum tolerated dose (MTD) is defined as the highest dose of margin-intensive SBRT delivered pre-operatively at which no more than 1 of 6 patients or 0 of 3 patients experiences a dose limiting toxicity (DLT)
Time Frame
30 days from SBRT day 1
Secondary Outcome Measure Information:
Title
Definitive resection rate
Time Frame
Surgery
Title
R0/R1/R2 resection margin rates
Time Frame
Pathological specimen evaluated at surgery
Title
Rate of pathological complete response
Time Frame
Pathological specimen evaluation post operation
Title
Any Late GI AE/other AE > grade 2 CTCAE v4.03
Time Frame
>1 month to 6 months post-surgery
Title
Overall survival and progression free survival at 12 and 24 months post D1 SBRT
Time Frame
12 and 24m FU

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Borderline resectable localised tumour of the pancreatic head/uncinate process/body as per NCCN Guidelines (tumours of the tail of pancreas are not eligible for inclusion) or operable tumour in contact with vein (SMV or PV) not causing distortion or narrowing as defined by CT +/- MRI +/- PET criteria within 28+/- 7 days prior to trial entry de novo or following chemotherapy. Histologically proven pancreatic ductal adenocarcinoma or cytological proven pancreatic malignancy. Able to undergo biliary drainage using a stent. Deemed fit and suitable for surgical resection. No overt metastases or uncertain status with investigations suspicious of possible metastatic disease (e.g. small equivocal pulmonary nodule(s)). Male or female, Age >= 16 years. Life expectancy of at least 6 months. ECOG performance status 0- 1 The patient is willing and able to comply with the protocol for the duration of the study, and scheduled follow-up visits and examinations. Written (signed and dated) informed consent and be capable of co-operating with protocol. Haematological and biochemical indices within defined ranges. Exclusion Criteria: Distant metastatic disease or local disease that cannot be encompassed in the SBRT field. History of previous or concurrent malignancy diagnoses for which the expected prognosis is likely to be worse than that for the current diagnosis of pancreatic cancer (excludes for example: e.g. localised prostate cancer, early colorectal cancer, early breast cancer, curatively-treated basal cell carcinoma of skin, carcinoma in situ of cervix; curatively treated cancer of other sites who are recurrence free for >3 years). Serious medical or psychological condition precluding trial intervention. Previous upper abdominal or right chest wall radiotherapy where 30% of the liver has received >15Gy. PPregnancy. Pregnant or breast-feeding women are ineligible. Women of childbearing potential must use effective methods of contraception. Any other psychological, social or medical condition, physical examination finding or laboratory abnormality that the Investigator considers makes the patient a poor trial candidate or could interfere with protocol compliance or the interpretation of the trial results.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Prof. Maria A Hawkins, MD FRCR MRCP
Organizational Affiliation
University of Oxford
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Beatson West of Scotland Cancer Centre
City
Glasgow
Country
United Kingdom
Facility Name
St James' Hospital
City
Leeds
Country
United Kingdom
Facility Name
Northern Centre for Cancer Care, The Freeman Hospital
City
Newcastle
Country
United Kingdom
Facility Name
City Hospital
City
Nottingham
Country
United Kingdom
Facility Name
The Churchill Hospital, Oxford University Hospitals Trust
City
Oxford
Country
United Kingdom

12. IPD Sharing Statement

Citations:
PubMed Identifier
33217498
Citation
Holyoake DLP, Robinson M, Silva M, Grose D, McIntosh D, Sebag-Montefiore D, Radhakrishna G, Mukherjee S, Hawkins MA. SPARC, a phase-I trial of pre-operative, margin intensified, stereotactic body radiation therapy for pancreatic cancer. Radiother Oncol. 2021 Feb;155:278-284. doi: 10.1016/j.radonc.2020.11.007. Epub 2020 Nov 18.
Results Reference
result
PubMed Identifier
27519585
Citation
Holyoake DL, Robinson M, Grose D, McIntosh D, Sebag-Montefiore D, Radhakrishna G, Patel N, Partridge M, Mukherjee S, Hawkins MA. Conformity analysis to demonstrate reproducibility of target volumes for Margin-Intense Stereotactic Radiotherapy for borderline-resectable pancreatic cancer. Radiother Oncol. 2016 Oct;121(1):86-91. doi: 10.1016/j.radonc.2016.08.001. Epub 2016 Aug 9.
Results Reference
derived
Links:
URL
https://pubmed.ncbi.nlm.nih.gov/33217498/
Description
Results paper

Learn more about this trial

SBRT Pre-operatively for Pancreatic Cancer

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