Performance and Safety of Biology-Guided Radiotherapy Using the RefleXion Medical Radiotherapy System (BIOGUIDE-X) (BIOGUIDE-X)
Cancer, Tumor, Solid, Cancer, Lung
About this trial
This is an interventional other trial for Cancer focused on measuring Radiation Oncology, Radiotherapy, Biology-Guided Radiotherapy (BgRT), RefleXion Medical, Radiation Therapy
Eligibility Criteria
Inclusion Criteria: Age greater than 21 years A new or prior diagnosis of biopsy-proven cancer with a solid tumor (non-hematologic, non-lymphoma) At least one active tumor in the bone or lung which is either the primary tumor or metastatic lesion determined either by biopsy or imaging suspicious of active disease Target tumor size ≥2cm and ≤5cm Target lesion in the bone or lung that is discrete and assessed by the investigator to be FDG-avid (i.e. SUVmax≥6 on third-party diagnostic PET/CT performed within 60 days with no intervening oncologic therapies) ECOG Performance Status 0-3 Must have completed any other oncologic therapies at least 15 days prior to planned start of study procedures (preferably 30 days) and must have no plans to initiate systemic therapy until after study follow up is complete -OR- must be recorded by physician to have an active candidate lesion that is unresponsive to ongoing systemic therapy. Females of childbearing potential should have negative urine or serum pregnancy test within 14 days prior to initiation of study scans. Demonstrate adequate organ function: determined by ANC, platelets, hemoglobin, with no gross hematuria For Cohort II only: Patient is dispositioned to undergo SBRT to a bone or lung tumor Exclusion Criteria: Clinically significant blood glucose abnormalities that preclude a satisfactory FDG PET/CT scan. Previous history of external radiotherapy where prior radiotherapy fields are anticipated to overlap with the radiotherapy fields required for the present study Diffuse metastatic process (leptomeningeal disease, peritoneal carcinomatosis, diffuse bone marrow involvement, etc.) PET-avid structures not intended for radiation are within 2cm from target on third-party diagnostic PET/CT as assessed by investigator Known allergy to FDG Known psychiatric or substance abuse disorder that would interfere with conduct of the study Pregnant, breast-feeding or expecting to conceive during the study Patient weight exceeding the weight limit outlined per IFU. For Cohort II only: Patients with pacemakers and other implantable devices who are deemed to be at high risk by the treating physician for complications secondary to radiotherapy. For Cohort II only: Patients with bone lesions who are determined to be high risk by the treating physician for pathologic fracture prior to beginning radiotherapy. For Cohort II only: Active inflammatory bowel disease, scleroderma, or other disorder deemed to be a risk factor for excess toxicity in the area of treatment by the treating physician.
Sites / Locations
- Stanford University
- UT Southwestern
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Cohort I: RRFD Cohort
Cohort II: Emulated Delivery Cohort
Cohort I seeks to identify the Recommended RefleXion FDG dose (RRFD), which is the dose of administered FDG that allows for functioning of the RefleXion system. This phase of the investigation seeks to optimize the balance between minimizing patient exposure to the radiotracer and achieving satisfactory performance of the RMRS PET subsystem for BgRT. The dose levels of 15 mCi and 20 mCi (if required) will be assessed sequentially in an escalation protocol. To determine the RRFD, a modified 3+3 design will be utilized wherein meeting the Activity Concentration threshold - not dose-limiting toxicity as is typically used - will be the relevant criteria for escalating from one dose to the next. Up to 12 participants will be enrolled in Cohort I, and will undergo one RMRS imaging session and one third-party Positron Emission Tomography (PET) /CT imaging session.
After the RRFD is determined by Cohort I, Cohort II enrollment will start enrollment. Cohort II seeks to determine whether BgRT dose distributions generated from Limited Time Sample (LTS) RMRS PET images obtained at the time of treatment delivery are consistent with the approved BgRT plan. To achieve this objective, RMRS PET scans will be added to the SBRT workflow at timepoints representing some of the instances when the RMRS PET subsystem would be utilized during a BgRT workflow. Specifically, subjects will undergo RMRS PET collections at the time of planning, and then before the first and final fractions of their planned course of SBRT treatment. Up to 22 participants will be enrolled in Cohort II, and will undergo three RMRS imaging sessions and one third-party Positron Emission Tomography (PET) /CT imaging session.