Daily Online Adaptation Versus Localization for MRI-Guided SBRT for Unresectable Primary or Oligometastatic Abdominal Malignancies
| Status: | Terminated |
|---|---|
| Conditions: | Liver Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Pancreatic Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/5/2019 |
| Start Date: | January 19, 2017 |
| End Date: | March 19, 2018 |
A Randomized Controlled Phase II Study of Daily Online Adaptation Versus Localization for MRI-Guided SBRT for Unresectable Primary or Oligometastatic Abdominal Malignancies
In light of this new technology and preliminary findings of low toxicity of online, adaptive,
magnetic resonance (M)-guided stereotactic radiation on a single arm prospective study, the
investigators propose to compare this technique to online MR-guided stereotactic body
radiation therapy (SBRT) without adaptation. Online plan adaptation increases treatment times
for patients and comprises an increased burden on technical and clinical staff. Although
preliminary trial results are encouraging, it remains unclear if the dosimetric benefits of
online-adaptive planning studies will translate to measurable improvements in clinical
outcomes that merit its routine use. In our preliminary study, plan adaptation was most often
required when tumors were adjacent to the gastrointestinal tract (the esophagus to the
sigmoid colon), as those structures were most commonly the dose-limiting structures and were
noted to change in location on a day-to-day basis. For these reasons, abdominal disease sites
have historically highlighted the limitations of SBRT. Specifically, the investigators will
enroll patients with oligometastatic or unresectable primary disease of the non-liver abdomen
to a randomized, prospective trial.
Patients will be randomized to one of two treatment arms, in which they will receive either
online-adaptive, MRI-guided SBRT or non-adaptive MRI-guided SBRT. Both patient groups will
undergo MRI simulation and MRI treatment localization with online MR monitoring and/or
gating. All patients will be treated in five fractions over one to two weeks. By adhering to
strict normal tissue constraints, the investigators expect toxicity to be within the current
standard of care for the non-adaptive arm, with reduction in toxicity in the arm of patients
who undergo adaptation based on daily anatomic changes.
magnetic resonance (M)-guided stereotactic radiation on a single arm prospective study, the
investigators propose to compare this technique to online MR-guided stereotactic body
radiation therapy (SBRT) without adaptation. Online plan adaptation increases treatment times
for patients and comprises an increased burden on technical and clinical staff. Although
preliminary trial results are encouraging, it remains unclear if the dosimetric benefits of
online-adaptive planning studies will translate to measurable improvements in clinical
outcomes that merit its routine use. In our preliminary study, plan adaptation was most often
required when tumors were adjacent to the gastrointestinal tract (the esophagus to the
sigmoid colon), as those structures were most commonly the dose-limiting structures and were
noted to change in location on a day-to-day basis. For these reasons, abdominal disease sites
have historically highlighted the limitations of SBRT. Specifically, the investigators will
enroll patients with oligometastatic or unresectable primary disease of the non-liver abdomen
to a randomized, prospective trial.
Patients will be randomized to one of two treatment arms, in which they will receive either
online-adaptive, MRI-guided SBRT or non-adaptive MRI-guided SBRT. Both patient groups will
undergo MRI simulation and MRI treatment localization with online MR monitoring and/or
gating. All patients will be treated in five fractions over one to two weeks. By adhering to
strict normal tissue constraints, the investigators expect toxicity to be within the current
standard of care for the non-adaptive arm, with reduction in toxicity in the arm of patients
who undergo adaptation based on daily anatomic changes.
Inclusion Criteria:
- Oligometastatic disease or unresectable primary abdominal malignancy with
biopsy-proven primary disease histology of solid tumor categorization. Patients with a
diagnosis of hepatocellular carcinoma do not require a biopsy.
- No more than three progressive sites of disease, with at least one of the disease
sites to be deemed suitable for treatment with MRI-guided, online adaptive SBRT to the
non-liver abdomen as per radiation oncology evaluation.
- Must be treated per protocol to lesion(s) of a single abdominal site that can
reasonably be encompassed within a single treatment field. Treatment of additional
site(s) outside of the abdomen while the patient is on trial is acceptable.
- The treated lesion must be within 2 cm of the abdominal gastrointestinal tract
(abdominal esophagus to sigmoid colon) on the basis of cross sectional imaging study
such as computed tomography (CT), positron emission tomography (PET)/CT, or MRI.
- Must be deemed medically fit for SBRT by the treating physician.
- At least 18 years of age.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
- Must have completed any systemic therapy at least one week prior to planned start of
SBRT (two weeks preferred), and must have no plans to initiate systemic therapy for at
least one week following end of SBRT (two weeks preferred).
- Women of childbearing 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 must inform her treating physician
immediately.
- Able to understand and willing to sign an Institutional Review Board (IRB) approved,
written informed consent document (or that of legally authorized representative, if
applicable).
Exclusion Criteria:
- Primary disease of hematologic origin, lymphoma, or small cell cancer.
- Past history of external beam radiotherapy within the projected treatment field of any
of the disease sites to be treated by MRI-guided, online adaptive SBRT.
- Currently receiving any other investigational agents.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac
arrhythmia.
- Pregnant and/or breastfeeding. Patient must have a negative pregnancy test within 14
days of study entry.
- Medical contraindication to undergoing MR imaging.
We found this trial at
1
site
660 S Euclid Ave
Saint Louis, Missouri 63110
Saint Louis, Missouri 63110
(314) 362-5000
Principal Investigator: Parag Parikh, M.D.
Phone: 314-362-9703
Washington University School of Medicine Washington University Physicians is the clinical practice of the School...
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