Evaluating Stereotactic Body Radiation Therapy for Oligometastatic Disease of the Bone
Bone Cancer
About this trial
This is an interventional treatment trial for Bone Cancer focused on measuring Bone Cancer
Eligibility Criteria
Inclusion Criteria:
Both cohorts:
--≥18 years of age
- ECOG performance status ≤2
- Pathologically proven metastatic solid tumor (non-hematologic malignancy) of the bone (spine or non-spine bone)
- Bony metastatic lesions must be ≤6 cm in maximum dimension and evaluable on either a CT or MRI scan; metastatic lesions in the spine must involve ≤3 contiguous vertebral bodies
- No other active malignancy within the past 2 years, except for non-melanoma skin cancers or carcinoma in situ of the cervix
- Ability to understand and the willingness to sign a written informed consent document
- Surgery to the lesion in question is allowed if size criteria outlined above are met
- Not currently pregnant or breast feeding
Cohort 1: Oligometastatic state
- Oligometastatic state is defined by ≤ 3 active sites of disease, including the primary site
- Agreement of both the Chow et al.15 and TEACHH16 models, indicating a median life expectancy of >3 months
- Among patients with multiple sites of metastatic disease, the other sites that will not be treated on this protocol have either been previously treated or are planned for local treatment
Cohort 2: Re-irradiation
- Previous radiation in the current area of disease requiring radiation
- Life expectancy of >3 months as defined by agreement of both the Chow et al.15 and TEACHH16 models
Exclusion Criteria:
- SBRT target size >6 cm in maximum diameter (or >100 cc in volume)
- Hematologic malignancies (including lymphoma, multiple myeloma)
- Prior RT of greater dose intensity than 100 Gy2 based on a biological effective dose (BED) calculation [BED (Gy2) = nd x (1+d/α/ß; where n=number of fractions, d=dose per fraction, α/ß=2)]
- Epidural tumor <2 mm from spinal cord
- Requirement of active receipt of systemic therapies concurrent with SBRT (concurrent hormonal therapies are allowed)
- Inability to lie flat and still for treatment delivery despite anti-anxiety and/or pain medications
- Non-English speakers are excluded from this study due to use of questionnaires which have not been validated in other languages.
- Patients lacking the capacity to describe their symptoms are excluded as that precludes them (or anyone on their behalf) from filling out the validated questionnaires about symptoms/toxicity.
- Pregnant women are excluded from this study because radiotherapy has the potential for teratogenic or abortifacient effects.
- Individuals with a history of a different malignancy are ineligible except for the following circumstances: if they have been disease-free for at least 2 years and are deemed by the investigator to be at low risk for recurrence of that malignancy; or if diagnosed and treated within the past 2 years for cervical cancer in situ or basal cell or squamous cell carcinoma of the skin.
Sites / Locations
- Dana Farber Cancer Institute
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Oligometastatic Disease
Re-irradiation to Metastatic Disease
Stereotactic Body Radiation Therapy (SBRT)to up to 3 sites of disease occurring in the bone or spine Treatments will be delivered on a dedicated stereotactic linear accelerator that includes onboard conebeamCT imaging and orthogonal 2D/3D matching with robotic couch top. Dosage will be determined by physician
Stereotactic Body Radiation Therapy (SBRT) to site(s) of disease occurring in the bone or spine Treatments will be delivered on a dedicated stereotactic linear accelerator that includes onboard conebeamCT imaging and orthogonal 2D/3D matching with robotic couch top. Dosage will be determined by physician