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A Phase I/II Study of Hypofractionated Proton Therapy for Stage II-III Non-Small Cell Lung Cancer
Conditions
Lung Neoplasms
Conditions: official terms
Carcinoma, Non-Small-Cell Lung - Lung Neoplasms
Conditions: Keywords
Non Small Cell Lung Cancer, Cancer, Lung, Proton, Radiation
Study Type
Interventional
Study Phase
Phase 1/Phase 2
Study Design
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Intervention
Name: Radiation Concurrent Chemotherapy
Type: Radiation
Overall Status
Recruiting
Summary
The purpose of this research study is to compare the effects (good and bad) on subjects and their cancer using standard chemotherapy in combination with hypofractionated proton radiation therapy. Hypofractionation is a technique that delivers higher daily doses of radiation over a shorter period of time.
Detailed Description
Conventional fractionated photon-based radiotherapy to 60-63 Gy at 1.8-2 Gy/fraction with concurrent chemotherapy remains the standard treatment practice in patients with stage III non-small cell lung carcinoma (NSCLC) with local control rates of approximately 50% and a median overall survival of just 18 months.Unfortunately, even the standard treatment has significant toxicity with approximately 40% of patients developing grade 3 or higher acute toxicities in the RTOG 9410 study.1 These outcomes are poor and more effective treatment regimens are needed.
Higher doses of radiation have been hypothesized to improve local control in patients with stage III NSCLC. This is expected to translate into better overall survival.Given the significant improvements in outcome in patients receiving hypofractionation for stage I NSCLC, perhaps similar gains could be achieved if hypofractionated radiotherapy could be safely delivered to stage II-III NSCLC with concurrent chemotherapy. Hypofractionated radiotherapy may offer improvement in local control compared with conventional fractionation that may translate into improved overall survival. Furthermore, hypofractionation will shorten the time interval during which patients are receiving less aggressive chemotherapy. Proton therapy is a highly conformal radiotherapy technique that takes advantage of the proton's characteristic Bragg Peak, resulting in significant reductions in the exit dose of the treatment beam. Thus, proton therapy can substantially reduce the dose to critical structures even compared with IMRT.
This study will investigate the safety and efficacy of delivering hypofractionated proton therapy with concurrent chemotherapy in patients with stage II-III NSCLC
Higher doses of radiation have been hypothesized to improve local control in patients with stage III NSCLC. This is expected to translate into better overall survival.Given the significant improvements in outcome in patients receiving hypofractionation for stage I NSCLC, perhaps similar gains could be achieved if hypofractionated radiotherapy could be safely delivered to stage II-III NSCLC with concurrent chemotherapy. Hypofractionated radiotherapy may offer improvement in local control compared with conventional fractionation that may translate into improved overall survival. Furthermore, hypofractionation will shorten the time interval during which patients are receiving less aggressive chemotherapy. Proton therapy is a highly conformal radiotherapy technique that takes advantage of the proton's characteristic Bragg Peak, resulting in significant reductions in the exit dose of the treatment beam. Thus, proton therapy can substantially reduce the dose to critical structures even compared with IMRT.
This study will investigate the safety and efficacy of delivering hypofractionated proton therapy with concurrent chemotherapy in patients with stage II-III NSCLC
Criteria for eligibility
Healthy Volunteers: No
Maximum Age: N/A
Minimum Age: 18 Years
Gender: Both
Criteria: Inclusion Criteria:
- Pathologically confirmed invasive non-small cell lung cancer within 12 weeks prior to study registration. OR Pathologically confirmed invasive non-small cell lung cancer within 6 months prior to study registration if the patient received induction chemotherapy.
- AJCC (American Joint Committee on Cancer) 7th Ed. clinical stage II-III.
- ECOG Performance status 0-1 within 8 weeks prior to study registration.
- Patient must give study-specific informed consent on an IRB-approved consent prior to any research-related procedures or study treatment.
- Patient must be at least 18 years old at the time of consent.
- Patient must complete all required tests in section 4.
- Lab results per the following within 4 weeks prior to study registration:
- Absolute neutrophil count (ANC) >1,800 cells/mm3.
- Platelets > = 100,000 cells/mm3.
- Hemoglobin > =10 g/dl. The use of transfusion or other intervention to achieve Hgb ≥10.0 g/dl is acceptable.
- AST/SGOT and ALT/SGPT < 2.5 x the institutional upper limit of normal (IULN).
- Post exploratory thoracotomy must be done > 3 weeks prior to study registration or patient did not have post exploratory thoracotomy
- PFT (pulmonary function test) with a FEV1 > 1 liters/second within 16 weeks prior to study registration.
Exclusion Criteria:
- Evidence of distant metastasis (M1) involvement.
- Prior radiotherapy to thoracic area.
- Unintentional weight loss >10% within 4 weeks prior to study registration.
- Previous or concomitant malignancy within 3 years other than:
- Curatively treated carcinoma in situ of the cervix, breast, or oral cavity.
- Basal or squamous cell carcinoma of the skin.
- Curatively treated superficial transitional cell carcinoma of the urinary bladder.
- Low risk (T1c-T2a and PSA<10ng/ml and Gleason score <7) prostate cancer.
- Other early stage tumor treated more than 2 years ago for cure.
- Prior tumor resection.
- On home oxygen therapy (intermittent or continuous).
- Pregnant and/or breast-feeding women, or patients (men and women) of child-producing potential not willing to use medically acceptable forms of contraception while on study treatment and for at least 12 months after study treatment. Pregnancy testing is not necessary for women who have had a hysterectomy or have not had a menstrual period for at least 24 consecutive months. Please document as such.
- Pathologically confirmed invasive non-small cell lung cancer within 12 weeks prior to study registration. OR Pathologically confirmed invasive non-small cell lung cancer within 6 months prior to study registration if the patient received induction chemotherapy.
- AJCC (American Joint Committee on Cancer) 7th Ed. clinical stage II-III.
- ECOG Performance status 0-1 within 8 weeks prior to study registration.
- Patient must give study-specific informed consent on an IRB-approved consent prior to any research-related procedures or study treatment.
- Patient must be at least 18 years old at the time of consent.
- Patient must complete all required tests in section 4.
- Lab results per the following within 4 weeks prior to study registration:
- Absolute neutrophil count (ANC) >1,800 cells/mm3.
- Platelets > = 100,000 cells/mm3.
- Hemoglobin > =10 g/dl. The use of transfusion or other intervention to achieve Hgb ≥10.0 g/dl is acceptable.
- AST/SGOT and ALT/SGPT < 2.5 x the institutional upper limit of normal (IULN).
- Post exploratory thoracotomy must be done > 3 weeks prior to study registration or patient did not have post exploratory thoracotomy
- PFT (pulmonary function test) with a FEV1 > 1 liters/second within 16 weeks prior to study registration.
Exclusion Criteria:
- Evidence of distant metastasis (M1) involvement.
- Prior radiotherapy to thoracic area.
- Unintentional weight loss >10% within 4 weeks prior to study registration.
- Previous or concomitant malignancy within 3 years other than:
- Curatively treated carcinoma in situ of the cervix, breast, or oral cavity.
- Basal or squamous cell carcinoma of the skin.
- Curatively treated superficial transitional cell carcinoma of the urinary bladder.
- Low risk (T1c-T2a and PSA<10ng/ml and Gleason score <7) prostate cancer.
- Other early stage tumor treated more than 2 years ago for cure.
- Prior tumor resection.
- On home oxygen therapy (intermittent or continuous).
- Pregnant and/or breast-feeding women, or patients (men and women) of child-producing potential not willing to use medically acceptable forms of contraception while on study treatment and for at least 12 months after study treatment. Pregnancy testing is not necessary for women who have had a hysterectomy or have not had a menstrual period for at least 24 consecutive months. Please document as such.
Locations
University of Florida Proton Therapy Institute
Jacksonville, Florida, United States
CDH Proton Center
Status: Recruiting
Contact: Judy Taylor-Holland - 904-588-1401
Warrenville, Illinois, United States
Princeton ProCure Management LLC
Status: Recruiting
Contact: Shirley Samuel - 630-657-0096
Somerset, New Jersey, United States
ProCure Proton Therapy Center
Status: Recruiting
Contact: Carl Brown - 732-357-2676 - carl.brown@nj.procure.com
Oklahoma City, Oklahoma, United States
Hampton University Proton Therapy Institute
Status: Recruiting
Contact: Tisha Adams, MS,CCRC - 405-773-6775 - tisha.adams@okc.procure.com
Hampton, Virginia, United States
Status: Recruiting
Contact: Scott Acker - 757-251-6856 - scott.acker@hamptonproton.org
Start Date
March 2013
Sponsors
Proton Collaborative Group
Source
Proton Collaborative Group
Record processing date
ClinicalTrials.gov processed this data on July 28, 2015
ClinicalTrials.gov page