A pilot study of two new imaging scans after high precision radiation therapy for patients with limited secondary spread of cancer to the lung.

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Stereotactic body radiotherapy (SBRT) is an new form of cancer treatment involving highly precise radiotherapy. SBRT appears to be very effective in controlling cancer. After the treatment is given, however, with standard scans we have not been able to reliably assess how well the treatment worked. We propose to research SBRT with state-of-the-art scanning tools in patients with cancer spread to the lung. We aim to better understand how cancer responds to this therapy. This is the first step of the research, and is a small ‘pilot’ study. The ‘pilot’ is designed to assess whether the research can be completed. Who is it for? This trial is for patients who have cancer which has spread to the lung. We aim to enrol ten patients in total to participate in the research. These patients will be invited through Peter MacCallum at East Melbourne. Trial details: If you participate in this study you will have two different types of scans as well as a single stereotactic body radiotherapy session (SBRT). The two types of scans we are researching are called a four-dimensional positron emission tomography (4D-PET) scan and a computed tomography (CT) perfusion scan. Both scans are slow and recorded along with your breathing, which allows us to see how much your organs move as you breathe in and out. Each 4D-PET scan is broken down into many separate scans, each showing where your organs and the cancer are at a specific point of your breathing, for example, just as you start breathing in. For us to know whether you are breathing in or out, we will monitor your chest movement using breathing equipment. This will be done by either putting a belt around your chest or abdomen which senses your breathing, or a small lightweight reflective box on your chest and watch this using a special camera in the room. Both devices can tell us at which part of your breathing cycle each CT or PET image was taken, so we can make sets of images from each phase. Either device can be used during your scan, and this will depend on the particular machine on which you have your scan taken. The CT perfusion scan is similar to a standard CT scan, but is taken over a longer period of time with more contrast. This allows us to record the flow of contrast and blood flow into the cancer. Specifically, the research involves: 1. Before treatment, you will have a four-dimensional positron emission tomography (4D-PET) scan and a computed tomography (CT) perfusion scan, as a baseline. 2. After treatment, you will have another 4D-PET scan and a CT perfusion scan at day 14 and day 70. These will be compared with the first scans in order to assess how your cancer responded to the treatment. The stereotactic body radiotherapy (SBRT) treatment itself will routinely involve a third type of scan: a cone-beam CT. This scan is performed on the treatment machine, and is used to make the treatment more precise. Specifically, the stereotactic radiotherapy treatment involves as standard: 3. Prior to treatment whilst being set-up on the treatment machine, a cone-beam CT will be used to check the position of the cancer. This will be repeated immediately before the treatment and again mid-way through the treatment (a total of 3 cone-beam CTs). 4. A single high-precision, high-dose radiotherapy (SBRT) treatment directed against the cancer. Follow-up will involve a visit at approximately 2.5 to 3 months, and then at 6 months, 9 months, and 12 months from treatment. Participation in this study will involve no extra cost due to either having these scans or the treatment.

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