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Dose Escalation Study of CyberKnife® SBRT Boost for Patients With Unresectable Locally Advanced Pancreatic Cancer

Primary Purpose

Pancreatic Carcinoma Non-resectable

Status

Terminated

Phase

Not Applicable

Locations

Canada

Study Type

Interventional

Intervention

CyberKnife® Stereotactic Body Radiotherapy(SBRT)Boost

About this trial

This is an interventional treatment trial for Pancreatic Carcinoma Non-resectable focused on measuring pancreas, pancreatic, unresectable, CyberKnife, SBRT

Eligibility Criteria

19 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Histological or Pathologically confirmed pancreatic adenocarcinoma
T1 - T4 or N0-N1 pancreatic adenocarcinoma
ECOG performance status ≤ 2
Male and female, aged ≥ 19- 80 years
Signed study-specific informed consent
General condition considered feasible for radiotherapy
INR ≤1.5 within 7 days prior to fiducial placement

Exclusion Criteria:

Diagnosis of distant metastatic disease
Primary tumor > 5 cm in maximum diameter on any imaging modality
>3 involved lymph nodes as per staging CT and/or PET-CT
Clear indication of involvement of duodenal wall on imaging or at time of endoscopy
Evidence of peritoneal carcinomatosis, portal vein occlusion, ascites or involvement of non-regional lymph nodes
Histology clearly other than adenocarcinoma
Disease cannot be radiographically assessed due to patient related contraindications or due to lack of visible tumor on pre-treatment imaging
More than 1 prior chemotherapy regimen for pancreatic cancer or treatment for >6 months
Prior radiotherapy exposure that would overlap the anticipated study treatment fields
Treatment with any other investigational agent, within 30 days prior to entering this study
Prior chemotherapy for pancreatic cancer is permitted, although there should be 30 days between last dose and start of treatment on protocol
Past or current history of other malignancies (except non-melanoma skin cancer or carcinoma in-situ of the cervix) unless in complete remission for a minimum of 2 years from treatment start
Life expectancy < 12 months
Inability or unwillingness to comply with the protocol
Any medical condition which, in the opinion of the treating radiation oncologist, would make a radical course of radiotherapy to the upper abdomen unsafe
Pregnancy or lactation
Positive serum pregnancy test within 7 days of starting study treatment in pre-menopausal women and women < 2 years after the onset of menopause.
Female participants that are of childbearing potential unwilling or unable to use effective means of contraception while receiving the study interventions and 30 days after receiving the last dose of study interventions
Male participants ,unwilling or unable, or whose female partner is unwilling or unable, to use effective means of contraception while the participant is receiving the study interventions and 30 days after receiving the last dose of study interventions

Sites / Locations

The Ottawa Hospital Cancer Centre

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Radiotherapy Boost

Arm Description

All participants will receive the CyberKnife® Stereotactic Body Radiotherapy(SBRT)Boost treatment however, there are 5 dose levels that could be assigned according to Time-to-Event Continual Reassessment Method (TITE-CRM). Participants will be assigned to either receiving 6, 7, 8, 9 or 10 Gy X 3Fr.

Outcomes

Primary Outcome Measures

Toxicity defined as grade 3 or 4 gastro-intestinal or other non-haematological toxicity

Toxicity defined as grade 3 or 4 gastro-intestinal or other non-haematological toxicity felt to be related to radiotherapy to the upper abdomen, graded as per CTCAE 4.0 and occuring between 3 and 9 months post CyberKnife radiotherapy

Secondary Outcome Measures

CT scans will measure tumour response

Participant recurrence free survival (RFS), progression free survival (PFS), time to recurrence (TTR), and overall survival (OS) will be measured using CT scans at 3 month intervals during the first 9 months post CyberKnife radiotherapy and then 6 month intervals during the remainder of follow up phase.

CyberKnife radiation dose measured in Gy delivered to the tumour and surrounding organs vs. the frequency of grade 3-4 toxicity defined by CTCAE v4.0

To establish radiation dose-volume relationships for various organs and toxicity.

Full Information

NCT ID

NCT01872377

First Posted

October 12, 2012

Last Updated

April 13, 2020

Sponsor

Ottawa Hospital Research Institute

1. Study Identification

Unique Protocol Identification Number

NCT01872377

Brief Title

Dose Escalation Study of CyberKnife® SBRT Boost for Patients With Unresectable Locally Advanced Pancreatic Cancer

Official Title

Phase I Time-to-Event Continual Reassessment (TITE-CRM) Dose Escalation Trial of CyberKnife® Stereotactic Body Radiotherapy (SBRT) Boost With Concurrent Chemoradiotherapy for Patients With Unresectable Locally Advanced Pancreatic Cancer

Study Type

Interventional

2. Study Status

Record Verification Date

April 2020

Overall Recruitment Status

Terminated

Why Stopped

No longer recruiting patients to this study

Study Start Date

July 2013 (undefined)

Primary Completion Date

May 16, 2018 (Actual)

Study Completion Date

May 16, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

Ottawa Hospital Research Institute

4. Oversight

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

Currently the standard treatment for locally advanced, unresectable pancreatic cancer consists either of chemotherapy by itself or a combination of chemotherapy plus radiation therapy or no treatment at all. Unfortunately, no treatment thus far has been able to provide patients with a consistent chance for a cure although there are rare patients who will live for many years after treatment. For most patients the chemotherapy or chemotherapy plus radiation will maintain or improve quality of life by keeping the cancer under control for a period of time. Approximately 25-30% of patients with early pancreatic cancer who are able to have the cancer completely removed surgically will live beyond 5 years and will be considered cured. This tells us that aggressive treatment directed at the tumour in the pancreas can lead to cure. For the majority of patients who can not have an operation, giving more radiation as part of the treatment may be a strategy that results in better control of the tumour in the pancreas which may or may not result in patients living longer. The purpose of this study is to test the safety of adding a higher dose (a "boost" dose) of radiation using a radiation unit called CyberKnife when combined with standard chemotherapy and radiation for patients with locally advanced, unresectable pancreatic cancer. Participants on this study will receive a 'boost' dose of radiation which consists of 3 treatments over 1 week. The participants will then receive the standard of care treatment of chemotherapy and standard radiation therapy over a 5 week period, which will be followed by the conventional 20 weeks of chemotherapy alone. The participants will then be followed for progression of disease and toxicity related to the boost treatment for up to 5 years.

Detailed Description

Stereotactic body radiotherapy (SBRT) is a minimally invasive treatment technique that allows for ultra-high doses of radiation to be delivered to small areas with precision not previously possible using older equipment. The CyberKnife® Robotic Radiosurgery System (Accuray, Sunnyvale California, USA) is a radiation unit specifically designed to focus beams of radiation accurately anywhere in the body. It is able to track, detect and correct for any tumor movement during treatment by using a sophisticated image guidance system.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Pancreatic Carcinoma Non-resectable

Keywords

pancreas, pancreatic, unresectable, CyberKnife, 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

7 (Actual)

8. Arms, Groups, and Interventions

Arm Title

Radiotherapy Boost

Arm Type

Experimental

Arm Description

Intervention Type

Radiation

Intervention Name(s)

CyberKnife® Stereotactic Body Radiotherapy(SBRT)Boost

Intervention Description

Stereotactic body radiotherapy (SBRT) is a minimally invasive treatment technique that allows for ultra-high doses of radiation to be delivered to small areas with precision. In this study all participants will receive one of 5 dose levels that will be assigned according to Time-to-Event Continual Reassessment Method (TITE-CRM). Three fractions of various dose levels would be delivered over 5 to 10 days (typically Monday, Wednesday and Friday) with at least 36 hours between two sessions. In case of technical or medical problem, the authorized total treatment time is 12 days.

Primary Outcome Measure Information:

Title

Toxicity defined as grade 3 or 4 gastro-intestinal or other non-haematological toxicity

Description

Time Frame

up to 3 years

Secondary Outcome Measure Information:

Title

CT scans will measure tumour response

Description

Time Frame

up to 7 years

Title

CyberKnife radiation dose measured in Gy delivered to the tumour and surrounding organs vs. the frequency of grade 3-4 toxicity defined by CTCAE v4.0

Description

To establish radiation dose-volume relationships for various organs and toxicity.

Time Frame

up to 7 years

10. Eligibility

Sex

All

Minimum Age & Unit of Time

19 Years

Maximum Age & Unit of Time

80 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Histological or Pathologically confirmed pancreatic adenocarcinoma T1 - T4 or N0-N1 pancreatic adenocarcinoma ECOG performance status ≤ 2 Male and female, aged ≥ 19- 80 years Signed study-specific informed consent General condition considered feasible for radiotherapy INR ≤1.5 within 7 days prior to fiducial placement Exclusion Criteria: Diagnosis of distant metastatic disease Primary tumor > 5 cm in maximum diameter on any imaging modality >3 involved lymph nodes as per staging CT and/or PET-CT Clear indication of involvement of duodenal wall on imaging or at time of endoscopy Evidence of peritoneal carcinomatosis, portal vein occlusion, ascites or involvement of non-regional lymph nodes Histology clearly other than adenocarcinoma Disease cannot be radiographically assessed due to patient related contraindications or due to lack of visible tumor on pre-treatment imaging More than 1 prior chemotherapy regimen for pancreatic cancer or treatment for >6 months Prior radiotherapy exposure that would overlap the anticipated study treatment fields Treatment with any other investigational agent, within 30 days prior to entering this study Prior chemotherapy for pancreatic cancer is permitted, although there should be 30 days between last dose and start of treatment on protocol Past or current history of other malignancies (except non-melanoma skin cancer or carcinoma in-situ of the cervix) unless in complete remission for a minimum of 2 years from treatment start Life expectancy < 12 months Inability or unwillingness to comply with the protocol Any medical condition which, in the opinion of the treating radiation oncologist, would make a radical course of radiotherapy to the upper abdomen unsafe Pregnancy or lactation Positive serum pregnancy test within 7 days of starting study treatment in pre-menopausal women and women < 2 years after the onset of menopause. Female participants that are of childbearing potential unwilling or unable to use effective means of contraception while receiving the study interventions and 30 days after receiving the last dose of study interventions Male participants ,unwilling or unable, or whose female partner is unwilling or unable, to use effective means of contraception while the participant is receiving the study interventions and 30 days after receiving the last dose of study interventions

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Jason Pantarotto, MD

Organizational Affiliation

The Ottawa Hospital

Official's Role

Principal Investigator

Facility Information:

Facility Name

The Ottawa Hospital Cancer Centre

City

Ottawa

State/Province

Ontario

ZIP/Postal Code

K1H8L6

Country

Canada

12. IPD Sharing Statement

Learn more about this trial

Dose Escalation Study of CyberKnife® SBRT Boost for Patients With Unresectable Locally Advanced Pancreatic Cancer

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