Carcinoma, Hepatocellular
Conditions
Brief summary
Primary Objective: To compare the efficacy of TACE vs. CyberKnife SBRT in the treatment of locally recurrent HCC after initial TACE. Secondary Objectives: 1. To determine the progression-free survival of TACE vs. CyberKnife SBRT 2. To determine the overall survival of TACE vs. CyberKnife SBRT for locally recurrent HCC 3. To determine the toxicities associated with TACE or CyberKnife SBRT for the treatment of recurrent HCC.
Interventions
DEVICECyberKnife
Standard of Care
PROCEDURETACE
Standard of Care
DRUGCT Contrast
Standard of Care
DRUGdoxorubicin
Standard of Care
DRUGEpirubicin
Standard of Care
DRUG5-fluorouracil
Standard of Care
DRUGMitomycin C
Standard of Care
DRUGGemcitabine
Standard of Care
DRUGCisplatin
Standard of Care
DEVICESMANCS
Standard of Care
Sponsors
Accuray Incorporated
Albert Koong
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Confirmed hepatocellular carcinoma by one of the following: * Histopathology * One radiographic technique that confirms a lesion \>=2 cm with arterial enhancement with washout on delayed phase * Hepatic lesion in patients for whom surgical resection is not possible or would not result in an opportunity for cure * Radiographic evidence of persistent, progressive or recurrent disease in an area previously treated with TACE. This evaluation should be determined after 6 weeks of initial TACE * Multi-specialty evaluation whereby the recurrent liver lesion was deemed by both the attending radiation oncologist and interventional radiologist amenable to treatment by the respective modality * Eligible patients must undergo an IV contrast CT scan of the liver within 6 weeks of enrollment onto the study; a contrast enhanced liver MRI may be substituted for the IV contrast CT of the liver. * A recent serum AFP must also be obtained within 4 weeks of enrollment. * Unifocal liver tumors not to exceed 7.5 cm in greatest axial dimension. Multifocal lesions will be restricted to lesions that can be treated within a single target volume within the same liver segment and to an aggregate of 7.5cm as long as the dose constraints to normal tissue can be met * Eastern Clinical Oncology Group performance status 0, 1 or 2 * Patients with liver disease classified as Child Pugh class A/B; if Child's class B, score must be 8 or less * Albumin \>= 2.5 g/dL * Total bilirubin \<= 3 mg/dL * INR \<= 1.5 * Creatinine \<= 2.0 mg/dL * Age \>= 18 years old * Life expectancy\>= 6 months * Ability of the research subject or authorized legal representative to understand and the willingness to sign a written informed consent document.
Exclusion criteria
* Prior radiation for the recurrent liver tumors * Prior radiotherapy to the upper abdomen * Prior RFA to index lesion * Liver transplant * Tumors \>= 7.5 cm in greatest axial dimension * Portal vein thrombus * Large varices within 2 cm of index lesion (seen on cross section imaging) * Contraindication to receiving radiotherapy * Active gastrointestinal bleed within 2 weeks of study enrollment * Ascites refractory to medical therapy * Women who are pregnant * Administration of any systemic chemotherapy within the last 1 month * Presence of multifocal lesions located in different lobes of the liver or extrahepatic metastases * Participation in another concurrent SYSTEMIC treatment protocol * Prior history of malignancy other than HCC
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Freedom from local progression at 6 months and 12 months | 6 months and 12 months |
Secondary
| Measure | Time frame |
|---|---|
| Progression-free survival | at 6, 12 and 18 months |
| Overall survival | at 6, 12, 18 months and up to 3 years |
| Serum AFP levels | 1 month, 3 months, 6 months, 12 months and 18 months |
Countries
United States
Outcome results
None listed