Unspecified Adult Solid Tumor, Protocol Specific
Conditions
Brief summary
This phase I trial studies the side effects and best dose of 3-dimensional conformal radiation therapy (CRT) or intensity-modulated radiation therapy (IMRT) in treating patients with recurrent tumors. Radiation therapy (RT) uses high energy x rays to kill tumor cells. Palliative radiation therapy may help patients with recurrent tumors live more comfortably.
Detailed description
PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) of reirradiation with the pulsed low dose rate technique. SECONDARY OBJECTIVES: I. To investigate the dosimetric tolerance of normal structures to reirradiation with the pulsed low dose rate technique. II. To determine the palliative efficacy and quality of life in patients treated on this protocol. III. To determine duration of response and time to progression. OUTLINE: This is a dose-escalation study. Patients undergo 3-dimensional CRT or IMRT once daily (QD), 5 days a week for 10-30 days. Treatment continues in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every month for 6 months and then every 12 weeks thereafter.
Interventions
PROCEDUREquality-of-life assessment
Ancillary studies
RADIATIONintensity-modulated radiation therapy
Undergo IMRT
RADIATION3-dimensional conformal radiation therapy
Undergo 3-dimensional CRT
Sponsors
Fox Chase Cancer Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients must have histologically-confirmed malignancy * Patients must have recurrent or metastatic tumor located within a previously irradiated field * Tumor within the irradiated field is negatively impacting patient's quality of life or threatening catastrophic complication if left untreated as determined by the treating physician * Patient is not a candidate for, or has not demonstrated a significant local response to chemotherapy, biologic, hormonal ,or other therapies * Patient is not a surgical candidate or tumor is not surgically resectable, as documented by surgical oncologist * Information on previous radiation treatment, including total dose and fractionation must be available; additional information including radiation fields and dose-volume-histogram or isodose lines is preferable * Tumor sites eligible for inclusion on this protocol include thorax, abdomen, and pelvis * Patients must have measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 in the previously irradiated field * Women of childbearing potential must be non-pregnant (negative pregnancy test within 72 hours prior to radiation simulation, postmenopausal woman must have been amenorrheic for at least 12 months to be considered of non-childbearing potential) and nonlactating, and men and women must be willing to exercise an effective form of birth control (abstinence/contraception) while on study and for 3 months after therapy completed * Eastern Cooperative Oncology Group (ECOG) performance status determined to be between 0 and 3 * Absolute neutrophil count (ANC) \>= 1,500/ul * Platelets (PLT) \>= 75,000/ul * Subjects must sign a written informed consent and Health Insurance Portability and Accountability Act (HIPAA) consent prior to performance of study-specific procedures or assessments and must be willing to comply with treatment and follow-up
Exclusion criteria
* Patients who have had chemotherapy or radiotherapy to the reirradiation target within 4 weeks prior to entering the study * Concurrent chemotherapy or biologic therapy * A history of ataxia telangiectasia or other documented history of radiation hypersensitivity * Scleroderma or active connective tissue disease * For abdominal or pelvic irradiation: active inflammatory bowel disease * Serious, active infections requiring treatment with intravenous (IV) antibiotics * Uncontrolled intercurrent illness including, but not limited to, or psychiatric illness/social situations that would limit compliance with study requirements * Reirradiation targets located within the head, neck, or brain are excluded from this study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| MTD of reirradiation with the pulsed low dose rate technique | Up to 30 days | Defined as the dose level closest to, but not over that which is predicted to result in a dose limiting toxicity (DLT) rate of 20%, the target toxicity rate. Graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. A DLT is a grade \>= 4 acute or grade \>= 3 late toxicity of an organ system within the reirradiation field in the following categories: skin or subcutaneous tissues, gastrointestinal, hepatobiliary, nervous system, renal and urinary, reproductive system, vascular, or respiratory, thoracic and mediastinal disorders. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Palliative efficacy in terms of quality of life and pain levels | Up to 3 years | Assessed using European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 15 Palliative (QLQ-C15-PAL) and the Numeric Pain Scale. The mean and standard deviation will be estimated at each time point. |
| Duration of response | Up to 3 years | Measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented. Assessed using the RECIST 1.1 criteria. Estimated using Kaplan-Meier curves. |
| Time to progression | Up to 3 years | Assessed using the RECIST 1.1 criteria. Estimated using Kaplan-Meier curves. |
Countries
United States
Outcome results
None listed