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Effect of High Doses of Radiation on Bone Structure and Metabolism

Primary Purpose

Malignant Bone Tumors

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Radiation (Surgical Arm)
Radiation (Non-surgical Arm)
Malignant Tumor Surgery
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Malignant Bone Tumors focused on measuring Malignant bone tumors

Eligibility Criteria

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

Inclusion Criteria:

  • All laboratory tests that are a part of the eligibility criteria must be completed within 14 days prior to the date of registration. Diagnostic tests that are a part of the eligibility criteria must be performed within 30 days of the date of registration. Participants must meet the following criteria on screening examination to be eligible to participate in the study:
  • Study participants must have histologically confirmed primary malignant bone tumor in the sacrum for which surgery and radiation or radiation alone are planned.
  • Age 18 years or older. In children under the age of 8, tetracycline derivatives have been reported to stain tooth enamel yellow color. These considerations lead us to exclude young persons under the age of 18 from the study.
  • Participants must have normal organ and marrow function as defined below:

    • Total bilirubin within normal institutional limits
    • Aspartaataminotransferase (AST) (SGOT)/ Alanine-aminotransferase (ALT) (SGPT) < 2.5 X institutional upper limit of normal
    • Creatinine within normal institutional limits or creatinine clearance > 60 mL/min/1.73 m2 for subjects with creatinine levels about institutional normal limit
  • The effects of tetracyclines and radiation used in computer tomography on the developing human fetus are known to be detrimental. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  • Participants must be able to read and understand English language and have the ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

Participants who exhibit any of the following conditions at screening will not be eligible for admission into the study.

  • Participants who have had surgery, chemotherapy, or radiotherapy of the sacrum prior to entering the study
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to tetracyclines.
  • Pregnant or nursing
  • Uncontrolled inter current illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements

Sites / Locations

  • Massachusetts General Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Non Surgical-Radiation Only

Malignant Tumor Surgery And Radiation

Arm Description

Non-surgical candidates receive 72 up to 77.l4 Gy of radiation depending on the histology (72 Gy for osteosarcoma and chondrosarcoma and 77.4 Gy for chordoma

The standard treatment includes pre-operative radiation of 50.4 Gy, followed by a recovery period of approximately 4 to 5 weeks. Surgery involves removing the malignant tumor in the sacrum in one piece, preferably with a cuff of normal tissue around the tumor. After approximately 6 weeks of recovery, the patient is treated with another 19.8 Gy up to 27 Gy of radiation postoperatively depending on the final margin status (higher for gross residual disease). If the wound is not healed or there is another medical reason to delay adjuvant radiation, then radiation may begin later.

Outcomes

Primary Outcome Measures

Change in Bone Mineral Density (Tb. BMD)
Trabecular bone mineral density will be measured in mg/cm3 using volumetric Quantitative Computed Tomography (QCT) of L1, L2 and the vertebrae adjacent to the tumor.

Secondary Outcome Measures

Serum N-Telopeptide (NTX)
Indicator for Bone Formation, units reported in nmol NTX/mmol creatinine
Serum Tartrate-resistant Acid Phosphatase 5b (TRAP5b)
Indicator for Bone Formation, units reported in U/L
Serum Osteocalcin (OC)
Indicator for Bone Formation, units reported in ng/mL
Serum Type 1 Procollagen N-terminal (P1NP)
Indicator for systemic metabolism that can affect bone health, units reported in pg/mL
Serum Phosphate (P)
Indicators for systemic metabolism that can affect bone health, units reported in mg/dL
Serum 25-hydroxycalciferol Vit D (25-OH VitD)
Indicators for systemic metabolism that can affect bone health, units reported in nmol/L
Mineral Apposition Rate (MAR)
Tetracycline quadruple labeling method will be used and the unit of measure will be um/day
Bone Formation Rate (BFR/BS)
Tetracycline quadruple labeling method will be used and the unit of measure will be mm3/mm2/year
Mineralization Lag Time (Mlt)
Tetracycline quadruple labeling method will be used and the unit of measure will be days
Osteoblast Number (N.Ob/BPm)
Immunohistochemistry staining methods will be used and the unit of measure will be mm^-1
Osteoblast Surface (Ob. S/BS)
Immunohistochemistry staining methods will be used and the unit of measure will be mm^-1
Osteoclast Number (N.Oc/BPm)
Immunohistochemistry staining methods will be used and the unit of measure will be mm^-1
Osteoclast Surface (Oc.S/BS)
Immunohistochemistry staining methods will be used and the unit of measure will be mm^-1

Full Information

First Posted
November 21, 2014
Last Updated
November 8, 2021
Sponsor
Massachusetts General Hospital
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT02323295
Brief Title
Effect of High Doses of Radiation on Bone Structure and Metabolism
Official Title
Pilot Study of the Effect of High Doses of Radiation on Bone Metabolism and Structure in Patients Treated With Adjuvant Radiotherapy and Surgery for Sacral Tumors
Study Type
Interventional

2. Study Status

Record Verification Date
November 2021
Overall Recruitment Status
Completed
Study Start Date
July 2015 (undefined)
Primary Completion Date
July 2019 (Actual)
Study Completion Date
July 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is designed to characterize the effects of high energy radiation on bone breakdown, with a specific interest in reducing the rate of sacral fractures. Although radiation is very important in managing tumors, it is related to complications such as bone fractures. In this research study, the investigators are looking to determine changes in blood markers, bone density, and bone structure following radiation and to better understand the reason for these changes.
Detailed Description
Participants in the Surgical Arm of the study will be treated according to the schedule outlined in protocol for a combined treatment with surgery and adjuvant high dose radiotherapy. Patients in the non surgical arm of the the study will be treated according to the protocol being treated with radiotherapy alone.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malignant Bone Tumors
Keywords
Malignant bone tumors

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
12 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Non Surgical-Radiation Only
Arm Type
Experimental
Arm Description
Non-surgical candidates receive 72 up to 77.l4 Gy of radiation depending on the histology (72 Gy for osteosarcoma and chondrosarcoma and 77.4 Gy for chordoma
Arm Title
Malignant Tumor Surgery And Radiation
Arm Type
Experimental
Arm Description
The standard treatment includes pre-operative radiation of 50.4 Gy, followed by a recovery period of approximately 4 to 5 weeks. Surgery involves removing the malignant tumor in the sacrum in one piece, preferably with a cuff of normal tissue around the tumor. After approximately 6 weeks of recovery, the patient is treated with another 19.8 Gy up to 27 Gy of radiation postoperatively depending on the final margin status (higher for gross residual disease). If the wound is not healed or there is another medical reason to delay adjuvant radiation, then radiation may begin later.
Intervention Type
Radiation
Intervention Name(s)
Radiation (Surgical Arm)
Intervention Description
For surgical candidates, the standard treatment includes pre-operative radiation of 50.4 Gy, followed by a recovery period of approximately 4 to 5 weeks. After this surgery will take place. After approximately 6 weeks of recovery, to allow the surgical incision to heal, the patient is treated with another 19.8 Gy up to 27 Gy of radiation postoperatively depending on the final margin status (higher for gross residual disease)
Intervention Type
Radiation
Intervention Name(s)
Radiation (Non-surgical Arm)
Intervention Description
Non-surgical candidates receive 72 up to 77.14 Gy of radiation depending on the histology (72 Gy for osteosarcoma and chondrosarcoma and 77.4 Gy for chordoma)
Intervention Type
Procedure
Intervention Name(s)
Malignant Tumor Surgery
Intervention Description
Surgery involves removing the malignant tumor in the sacrum in one piece, preferably with a cuff of normal tissue around the tumor
Primary Outcome Measure Information:
Title
Change in Bone Mineral Density (Tb. BMD)
Description
Trabecular bone mineral density will be measured in mg/cm3 using volumetric Quantitative Computed Tomography (QCT) of L1, L2 and the vertebrae adjacent to the tumor.
Time Frame
Non-surgical arm: baseline, 3 months Surgical arm: baseline, 9 weeks
Secondary Outcome Measure Information:
Title
Serum N-Telopeptide (NTX)
Description
Indicator for Bone Formation, units reported in nmol NTX/mmol creatinine
Time Frame
Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months
Title
Serum Tartrate-resistant Acid Phosphatase 5b (TRAP5b)
Description
Indicator for Bone Formation, units reported in U/L
Time Frame
Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months
Title
Serum Osteocalcin (OC)
Description
Indicator for Bone Formation, units reported in ng/mL
Time Frame
Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months
Title
Serum Type 1 Procollagen N-terminal (P1NP)
Description
Indicator for systemic metabolism that can affect bone health, units reported in pg/mL
Time Frame
Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months
Title
Serum Phosphate (P)
Description
Indicators for systemic metabolism that can affect bone health, units reported in mg/dL
Time Frame
Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months
Title
Serum 25-hydroxycalciferol Vit D (25-OH VitD)
Description
Indicators for systemic metabolism that can affect bone health, units reported in nmol/L
Time Frame
Non-surgical arm: baseline, 3.5 weeks, 7 weeks, ~5 months, ~8 months Surgical arm: baseline, 5.5 weeks, 18.5 weeks, ~7 months, ~10 months
Title
Mineral Apposition Rate (MAR)
Description
Tetracycline quadruple labeling method will be used and the unit of measure will be um/day
Time Frame
Only surgical arm: The months after biopsies are taken during surgery (surgery is during week 4 and 5). These measurements will be done in batches so timeframe isn't clear.
Title
Bone Formation Rate (BFR/BS)
Description
Tetracycline quadruple labeling method will be used and the unit of measure will be mm3/mm2/year
Time Frame
Only surgical arm: The months after biopsies are taken during surgery (surgery is during week 4 and 5). These measurements will be done in batches so timeframe isn't clear.
Title
Mineralization Lag Time (Mlt)
Description
Tetracycline quadruple labeling method will be used and the unit of measure will be days
Time Frame
Only surgical arm: The months after biopsies are taken during surgery (surgery is during week 4 and 5). These measurements will be done in batches so timeframe isn't clear.
Title
Osteoblast Number (N.Ob/BPm)
Description
Immunohistochemistry staining methods will be used and the unit of measure will be mm^-1
Time Frame
Only surgical arm: The weeks after biopsies are taken during surgery (surgery is during week 4 and 5).
Title
Osteoblast Surface (Ob. S/BS)
Description
Immunohistochemistry staining methods will be used and the unit of measure will be mm^-1
Time Frame
Only surgical arm: The weeks after biopsies are taken during surgery (surgery is during week 4 and 5).
Title
Osteoclast Number (N.Oc/BPm)
Description
Immunohistochemistry staining methods will be used and the unit of measure will be mm^-1
Time Frame
Only surgical arm: The weeks after biopsies are taken during surgery (surgery is during week 4 and 5).
Title
Osteoclast Surface (Oc.S/BS)
Description
Immunohistochemistry staining methods will be used and the unit of measure will be mm^-1
Time Frame
Only surgical arm: The weeks after biopsies are taken during surgery (surgery is during week 4 and 5).

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: All laboratory tests that are a part of the eligibility criteria must be completed within 14 days prior to the date of registration. Diagnostic tests that are a part of the eligibility criteria must be performed within 30 days of the date of registration. Participants must meet the following criteria on screening examination to be eligible to participate in the study: Study participants must have histologically confirmed primary malignant bone tumor in the sacrum for which surgery and radiation or radiation alone are planned. Age 18 years or older. In children under the age of 8, tetracycline derivatives have been reported to stain tooth enamel yellow color. These considerations lead us to exclude young persons under the age of 18 from the study. Participants must have normal organ and marrow function as defined below: Total bilirubin within normal institutional limits Aspartaataminotransferase (AST) (SGOT)/ Alanine-aminotransferase (ALT) (SGPT) < 2.5 X institutional upper limit of normal Creatinine within normal institutional limits or creatinine clearance > 60 mL/min/1.73 m2 for subjects with creatinine levels about institutional normal limit The effects of tetracyclines and radiation used in computer tomography on the developing human fetus are known to be detrimental. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. Participants must be able to read and understand English language and have the ability to understand and the willingness to sign a written informed consent document. Exclusion Criteria: Participants who exhibit any of the following conditions at screening will not be eligible for admission into the study. Participants who have had surgery, chemotherapy, or radiotherapy of the sacrum prior to entering the study History of allergic reactions attributed to compounds of similar chemical or biologic composition to tetracyclines. Pregnant or nursing Uncontrolled inter current illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joseph H. Schwab, 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

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Effect of High Doses of Radiation on Bone Structure and Metabolism

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