'SOURCE - LUNG' Stereotactic Ablative Radiation Therapy Of UltRaCEntral LUNG Tumours (SOURCE Lung) (SOURCE Lung)
NSCLC/Oligometastatic Cancer (Single Lung Lesion)
About this trial
This is an interventional treatment trial for NSCLC/Oligometastatic Cancer (Single Lung Lesion) focused on measuring Lung cancer, Non-small cell lung cancer, Ultracentral, Stereotactic ablative radiation therapy, Oligometastatic cancer, Single lung lesion
Eligibility Criteria
Inclusion Criteria:
- Written informed consent obtained prior to any study-specific procedures
- ≥ 18 years of age
- Life expectancy >6 months
- ECOG (Eastern Cooperative Oncology Group) performance status 0-2
Histological diagnosis (biopsy or cytology) or radiological diagnosis (PET-positive FDG-avid tumour which requires local ablative therapy per Multi-Disciplinary Team (MDT) recommendations) of either:
(i) Primary NSCLC (Squamous Cell Carcinoma (SCC), Adenocarcinoma, Large Cell) OR (ii) Single pulmonary oligometastatic lesion
Patients with central lung tumours whose radiotherapy plan meets the following criteria:
(i) OAR eligibility constraints are initially exceeded when full PTV coverage is met; (ii) subsequently meets the SOURCE OAR constraints and meets SOURCE minimum constraints
- Inoperable (as per MDT) or patient refuses surgery,
- Females of childbearing potential must not be pregnant or lactating, must be prepared to take adequate contraception methods during treatment. Males whose female partners are of childbearing potential must be prepared to take adequate contraception methods during treatment. Examples of effective contraception methods are a condom or a diaphragm with spermicidal jelly, or oral, injectable or implanted birth control
- Absence of psychological, familial, sociological or geographical condition, or psychiatric illness/social situation potentially hampering compliance with the study protocol and follow-up schedule
Exclusion Criteria:
- Known co-existing or prior malignancy within the last 5 years (except for adequately treated basal cell carcinoma (BCC) or Squamous Cell Carcinoma (SCC) of the skin)) which is likely to interfere with treatment or assessment of outcomes
- Tumour/oligometastatic lesion that is abutting the oesophagus
- Evidence of regional (nodal) or distant metastases or metastatic pleural effusion
- Spinal canal involvement
- Patients with syndromes or conditions associated with increased radiosensitivity
- Idiopathic pulmonary fibrosis / usual interstitial pneumonia
- Chemotherapy and/or other targeted treatment administered within 3 months prior to study registration or planned for <6 weeks following radiotherapy
- Any previous radiotherapy to the thorax or mediastinum (excluding previous breast or chest wall radiotherapy) which is likely to interfere with treatment or assessment of outcomes
- Any tumour not clinically definable on the treatment planning CT scan (e.g. surrounding consolidation or atelectasis)
- Patients unable to undergo 4D-CT scan
- Uncontrolled intercurrent illness that is likely to interfere with treatment or assessment of outcomes
- Evidence of any other significant clinical disorder or laboratory finding that makes it undesirable for the patient to participate in the study, or if it is felt by the research / medical team that the patient may not be able to comply with the protocol.
Sites / Locations
- Beacon HospitalRecruiting
- St Luke's Radiation Oncology Network (SLRON) at St Luke's Hospital and St James's HospitalRecruiting
Arms of the Study
Arm 1
Experimental
Radiation
Treatment will be delivered via image-guided (IG)-SABR in 8 fractions of 7.5Gy. OAR constraints must be respected but minimum dose coverage of 75% to 95% of the PTV will be allowed and minimum dose of 75% to 99% of the GTV will be allowed. The minimums are chosen to represent at least an equivalent BED to the RT standard fractionation of 55 Gy in 20 fractions based on actual treatment dose of 7.5Gy in 8 fractions. A total of 60 evaluable patients will be required for the study. The sample size was calculated using continuous monitoring for toxicity, up to one year post RT, using a Pocock-type boundary. Accrual will be halted if excessive numbers of ≥ Grade 3 TxR-AEs are seen. The regime will not be considered to be safe if >25% of evaluable patients experience a ≥ Grade 3 treatment-related adverse event (TxR-AE) by the end of 1-year post-RT. This study will be considered adequately safe if ≤ 25% of evaluable patients experience ≥ Grade 3 TxR-AE by the end of 1 year post-RT.