Daily Adaptive Radiation Therapy: An Individualized Approach for Stage III Lung Cancer

Trial Title: Daily Adaptive Radiation Therapy: An Individualized Approach for Stage III Lung Cancer

NCT ID: NCT05488626

Condition: Stage III Non-small Cell Lung Cancer

Conditions: Official terms:
Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Immunomodulating Agents

Study type: Interventional

Study phase: N/A

Overall status: Active, not recruiting

Study design:

Allocation: Randomized

Intervention model: Parallel Assignment

Primary purpose: Treatment

Masking: None (Open Label)

Intervention:

Intervention type: Device
Intervention name: Adaptive Radiotherapy
Description: Standard fractionation external beam radiotherapy (60-66 Gy in 2 Gy/fraction) with daily online adaptation.
Arm group label: Adaptive Arm

Intervention type: Device
Intervention name: Non-Adaptive Radiotherapy
Description: Standard fractionation external beam radiotherapy (60-66 Gy in 2 Gy/fraction) with daily image guidance.
Arm group label: Non-Adaptive Arm

Intervention type: Drug
Intervention name: Chemotherapy
Description: Concomitant chemotherapy per NCCN or other national guidelines.
Arm group label: Adaptive Arm
Arm group label: Non-Adaptive Arm

Intervention type: Drug
Intervention name: Immunotherapy
Description: Adjuvant immunotherapy per national or institutional guidelines.
Arm group label: Adaptive Arm
Arm group label: Non-Adaptive Arm

Summary: This is a prospective multi-center randomized clinical trial designed to demonstrate that daily online adaptive radiotherapy with concomitant chemotherapy for stage III non-small cell lung cancer (NSCLC) will result in decreased acute respiratory and esophageal toxicity compared with non-adaptive radiotherapy with concomitant chemotherapy. The timepoint for this assessment will be 3 months following the end of radiotherapy and will use the Patient Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE).

Criteria for eligibility:
Criteria:
Inclusion Criteria: 1. Provision of signed and dated informed consent form. 2. Histologically confirmed NSCLC 3. Clinical stage IIIA-IIIB (AJCC v8) disease who are either: 1. Patients classified as non-operable by the treatment team 2. Patients who refuse surgery 4. Clinical stage IIIC due to contralateral mediastinal lymph node involvement only (e.g., no contralateral hilar or any supraclavicular/cervical lymph node metastases). Mediastinal stations 2R and 4R are considered contralateral for patients whose primary tumor is within the left lung. Mediastinal stations 2L, 4L, 5, and 6 are considered contralateral for patients whose primary tumor is in the right lung. 5. Completed evaluation for metastatic disease with no distant metastases identified. Evaluation must include the following: 1. History and physical examination within 30 days prior to enrollment. 2. Whole body FDG PET-CT for staging within 60 days prior to enrollment 3. Brain MRI or contrast enhanced CT within 60 days prior to enrollment. 6. ECOG performance status 0-2 and deemed clinically fit for chemoradiotherapy. 7. Age ≥18 years (or at least the local age of consent) 8. Patients must have normal organ and marrow function. 9. Serum creatinine ≤1.5 mg/dL within 60 days prior to enrollment. 10. Measurable disease must be present. 11. Negative urine or serum pregnancy test within 14 days prior to enrollment for women of childbearing potential. Exclusion Criteria: 1. Contralateral hilar or any supraclavicular/cervical lymph nodes. 2. Baseline grade ≥3 dyspnea, or cough, or dysphagia. 3. Prior invasive non-skin malignancy unless disease free for a minimum of 3 years. 4. History of prior RT to the thorax. 5. Severe imaging artifact that, in the view of the local investigator, would preclude accurate identification of the thoracic anatomy and tumor targets on the cone beam CT (e.g., artifact created implanted cardiac device in proximity to the targets). 6. Evidence of malignant pleural effusion, defined as either FDG PET avidity within effusion fluid or presence of malignant cells identified by cytology of thoracentesis fluid. 7. Severe active chronic obstructive pulmonary disease or respiratory illness other than NSCLC precluding study therapy. 8. Hospitalization for chronic obstructive pulmonary disease or respiratory illness other than NSCLC within 1 year prior to study enrollment. 9. Women of childbearing potential and sexually active women not willing or able to use contraception.

Gender: All

Minimum age: 18 Years

Maximum age: N/A

Healthy volunteers: No

Locations:

Facility:
Name: University of Alabama at Birmingham

Address:
City: Birmingham
Zip: 35294
Country: United States

Start date: October 20, 2022

Completion date: December 2028

Lead sponsor:
Agency: Varian, a Siemens Healthineers Company
Agency class: Industry

Source: Varian, a Siemens Healthineers Company

Record processing date: ClinicalTrials.gov processed this data on November 12, 2024

Source: ClinicalTrials.gov page: https://clinicaltrials.gov/ct2/show/NCT05488626