Bone Cancer
Conditions
Keywords
Bone Cancer
Brief summary
This research study is studying a form of radiation therapy called stereotactic body radiation therapy or SBRT as a possible treatment for Cancer that has spread to the spine or other bone
Detailed description
This research study is a Phase II clinical trial. Phase II clinical trials test the safety and effectiveness of an investigational intervention to learn whether the intervention works in treating metastases of the bone. Investigational means that the intervention is being studied. SBRT is an advanced technique that allows for more precise delivery of radiation than with standard radiation therapy. In comparison to standard radiation therapy, it allows us to give higher doses of radiation to a tumor while limiting the radiation dose going to the surrounding normal tissues. This technology has been made possible by advances in imaging and treatment capabilities on the radiation treatment machines. SBRT works just as standard radiation therapy works by damaging cancer cells. SBRT has been used to deliver radiation to people with cancer in the lung and those with metastases in the spine or liver. Studies of those groups have shown low rates of side effects with good rates of killing the cancer in that area and preventing it from coming back. In the current research study, the investigators are looking to further evaluate how well this type of radiation controls disease in bone and whether the toxicity (side effects) of SBRT differs from that of standard treatment. The investigators hypothesis is that toxicity might be less, as less normal tissue receives radiation with SBRT than with standard treatment. It is important to note that SBRT, just like standard radiation therapy for the participant disease, is being used to attempt to stop the growth of cancer cells in a bone metastasis and relieve or prevent any symptoms (ex. pain) associated with bone metastases. The goal of the SBRT is not to cure the participant cancer. The primary goal of the study is to see how well SBRT controls the disease in the bone, and the investigators also want to analyze its ability to control disease symptoms without added toxicity.
Interventions
DRUGStereotactic Body Radiation Therapy (SBRT)
DEVICEStereotactic Linear Accelerator
Sponsors
Dana-Farber Cancer Institute
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Both cohorts: --≥18 years of age * ECOG performance status ≤2 * Pathologically proven metastatic solid tumor (non-hematologic malignancy) of the bone (spine or non-spine bone) * Bony metastatic lesions must be ≤6 cm in maximum dimension and evaluable on either a CT or MRI scan; metastatic lesions in the spine must involve ≤3 contiguous vertebral bodies * No other active malignancy within the past 2 years, except for non-melanoma skin cancers or carcinoma in situ of the cervix * Ability to understand and the willingness to sign a written informed consent document * Surgery to the lesion in question is allowed if size criteria outlined above are met * Not currently pregnant or breast feeding * Cohort 1: Oligometastatic state * Oligometastatic state is defined by ≤ 3 active sites of disease, including the primary site * Agreement of both the Chow et al.15 and TEACHH16 models, indicating a median life expectancy of \>3 months * Among patients with multiple sites of metastatic disease, the other sites that will not be treated on this protocol have either been previously treated or are planned for local treatment * Cohort 2: Re-irradiation * Previous radiation in the current area of disease requiring radiation * Life expectancy of \>3 months as defined by agreement of both the Chow et al.15 and TEACHH16 models
Exclusion criteria
* SBRT target size \>6 cm in maximum diameter (or \>100 cc in volume) * Hematologic malignancies (including lymphoma, multiple myeloma) * Prior RT of greater dose intensity than 100 Gy2 based on a biological effective dose (BED) calculation \[BED (Gy2) = nd x (1+d/α/ß; where n=number of fractions, d=dose per fraction, α/ß=2)\] * Epidural tumor \<2 mm from spinal cord * Requirement of active receipt of systemic therapies concurrent with SBRT (concurrent hormonal therapies are allowed) * Inability to lie flat and still for treatment delivery despite anti-anxiety and/or pain medications * Non-English speakers are excluded from this study due to use of questionnaires which have not been validated in other languages. * Patients lacking the capacity to describe their symptoms are excluded as that precludes them (or anyone on their behalf) from filling out the validated questionnaires about symptoms/toxicity. * Pregnant women are excluded from this study because radiotherapy has the potential for teratogenic or abortifacient effects. * Individuals with a history of a different malignancy are ineligible except for the following circumstances: if they have been disease-free for at least 2 years and are deemed by the investigator to be at low risk for recurrence of that malignancy; or if diagnosed and treated within the past 2 years for cervical cancer in situ or basal cell or squamous cell carcinoma of the skin.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The 6-month Local Control Rate of SBRT | 6 months | The 6-month local control rate is the proportion of patients free of local failure at 6 months after stereotactic body radiation therapy (SBRT). Local failure is defined as the presence of biopsy-proven recurrence or radiologic scans that demonstrate progression at the treated sites. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With 1-year Local Progression-Free Survival | 1 year | The local progression-free survival is defined as the duration of time from registration to time of local failure or death. |
| Number of Participants With 2-year Progression-Free Survival | 2 year | Progression-free survival is defined as the duration of time from registration to time of any progression or death. |
| 2-year Overall Survival Rate | 2 year | Overall survival is defined as the time between registration and death. |
| Patient Reported Quality Of Life - Acute | 3 months | Patient reported QOL, symptoms and satisfaction will be assessed using the MDASI general questionnaire at baseline, during treatment and all follow-up visits. |
| Patient Reported Quality of Life - Chronic | 1 year | Patient reported QOL, symptoms and satisfaction will be assessed using the MDASI general questionnaire at baseline, during treatment and all follow-up visits. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Oligometastatic Disease Stereotactic Body Radiation Therapy (SBRT)to up to 3 sites of disease occurring in the bone or spine
* Treatments will be delivered on a dedicated stereotactic linear accelerator that includes onboard conebeamCT imaging and orthogonal 2D/3D matching with robotic couch top.
* Dosage will be determined by physician
Stereotactic Body Radiation Therapy (SBRT)
Stereotactic Linear Accelerator | 98 |
| Re-irradiation to Metastatic Disease Stereotactic Body Radiation Therapy (SBRT) to site(s) of disease occurring in the bone or spine
* Treatments will be delivered on a dedicated stereotactic linear accelerator that includes onboard conebeamCT imaging and orthogonal 2D/3D matching with robotic couch top.
* Dosage will be determined by physician
Stereotactic Body Radiation Therapy (SBRT)
Stereotactic Linear Accelerator | 44 |
| Total | 142 |
Baseline characteristics
| Characteristic | Re-irradiation to Metastatic Disease | Total | Oligometastatic Disease |
|---|---|---|---|
| Age, Continuous | 61.5 years STANDARD_DEVIATION 12.7 | 68.8 years | 72 years STANDARD_DEVIATION 10.4 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 4 Participants | 4 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 4 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 10 Participants | 9 Participants |
| Race (NIH/OMB) White | 37 Participants | 124 Participants | 87 Participants |
| Sex: Female, Male Female | 10 Participants | 90 Participants | 80 Participants |
| Sex: Female, Male Male | 34 Participants | 52 Participants | 18 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 28 / 98 | 29 / 44 |
| other Total, other adverse events | 27 / 98 | 41 / 44 |
| serious Total, serious adverse events | 2 / 98 | 1 / 44 |
Outcome results
Primary
The 6-month Local Control Rate of SBRT
The 6-month local control rate is the proportion of patients free of local failure at 6 months after stereotactic body radiation therapy (SBRT). Local failure is defined as the presence of biopsy-proven recurrence or radiologic scans that demonstrate progression at the treated sites.
Time frame: 6 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Oligometastatic Disease | The 6-month Local Control Rate of SBRT | 94 Participants |
| Re-irradiation to Metastatic Disease | The 6-month Local Control Rate of SBRT | 40 Participants |
Secondary
2-year Overall Survival Rate
Overall survival is defined as the time between registration and death.
Time frame: 2 year
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Oligometastatic Disease | 2-year Overall Survival Rate | 86 Participants |
| Re-irradiation to Metastatic Disease | 2-year Overall Survival Rate | 22 Participants |
Secondary
Number of Participants With 1-year Local Progression-Free Survival
The local progression-free survival is defined as the duration of time from registration to time of local failure or death.
Time frame: 1 year
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Oligometastatic Disease | Number of Participants With 1-year Local Progression-Free Survival | 82 Participants |
| Re-irradiation to Metastatic Disease | Number of Participants With 1-year Local Progression-Free Survival | 40 Participants |
Secondary
Number of Participants With 2-year Progression-Free Survival
Progression-free survival is defined as the duration of time from registration to time of any progression or death.
Time frame: 2 year
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Oligometastatic Disease | Number of Participants With 2-year Progression-Free Survival | 46 Participants |
| Re-irradiation to Metastatic Disease | Number of Participants With 2-year Progression-Free Survival | 16 Participants |
Secondary
Patient Reported Quality Of Life - Acute
Patient reported QOL, symptoms and satisfaction will be assessed using the MDASI general questionnaire at baseline, during treatment and all follow-up visits.
Time frame: 3 months
Secondary
Patient Reported Quality of Life - Chronic
Patient reported QOL, symptoms and satisfaction will be assessed using the MDASI general questionnaire at baseline, during treatment and all follow-up visits.
Time frame: 1 year