Stage II Prostate Adenocarcinoma AJCC v7
Conditions
Brief summary
This randomized phase III trial studies how well stereotactic body radiation therapy works compared to intensity-modulated radiation therapy in treating patients with stage IIA-B prostate cancer. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Stereotactic body radiation therapy uses special equipment to position a patient and deliver radiation to tumors with high precision. This method can kill tumor cells with fewer doses over a shorter period and cause less damage to normal tissue. Stereotactic body radiation therapy may work better in treating patients with prostate cancer.
Detailed description
PRIMARY OBJECTIVES: I. To determine whether stereotactic body radiation therapy (SBRT) can be shown to be superior to hypofractionated intensity-modulated radiation therapy (IMRT) in terms of genitourinary (GU) and gastrointestinal (GI) toxicity by having fewer patients that experience a minimal important decline (MID) in urinary irritation/obstructive and bowel Health Related Quality of Life (HRQOL) as measured by Expanded Prostate Cancer Index Composite (EPIC)-26 at 24 months post completion of therapy. II. To determine if SBRT (5 fractions of 7.25 Gy) is superior to hypofractionated IMRT (28 fractions of 2.5 Gy or 20 fractions of 3 Gy) as measured by disease free survival (DFS). SECONDARY OBJECTIVES: I. To determine whether SBRT can be shown to be superior to hypofractionated IMRT at 12 and 24 months post completion of therapy in terms of HRQOL by having fewer patients that experience a minimal important decline (MID) bowel (12 months only) sexual, hormonal, urinary irritation/obstructive (12 months only) and in urinary incontinence HRQOL as measured by EPIC-26. II. To determine if SBRT (5 fractions of 7.25 Gy) is superior to hypofractionated IMRT (28 fractions of 2.5 Gy or 20 fractions of 3 Gy) as measured by biochemical failure, overall survival, local failure, prostate cancer specific survival, and distant metastases. III. To determine the correspondence between the diagnostic magnetic resonance imaging (MRI) and biopsy. IV. To determine if prostate imaging-reporting and data system (PIRADS)version (v)2.1 = 4/5 disease is prognostic for biochemical failure. EXPLORATORY OBJECTIVES: I. To determine whether a potentially more expensive therapy, SBRT, would be cost-effective than standard hypofractionated IMRT as measured by the European Quality of Life Five Dimension Five Level Scale Questionnaire (EQ-5D-5L). II. To determine if disease characteristics captured on baseline and follow-up MRI can be used to predict which patients will respond to SBRT versus hypofractionated IMRT. III. To validate autosegmentation tools for the prostate and tumors. IV. Collect specimens for future translational research analyses. OUTLINE: Patients are randomized into 1 of 2 arms. ARM I: Patients undergo IMRT once daily for 5 fractions per week for 20 or 28 fractions over less than 32 business days. ARM II: Patients undergo SBRT at least every other day for 2-3 fractions per week over less than 17 business days. After completion of study treatment, patients are followed up every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.
Interventions
RADIATIONIntensity-Modulated Radiation Therapy
Undergo IMRT
OTHERQuality-of-Life Assessment
Ancillary studies
OTHERQuestionnaire Administration
Ancillary studies
RADIATIONStereotactic Body Radiation Therapy
Undergo SBRT
Sponsors
NRG Oncology
National Cancer Institute (NCI)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Previously untreated (no local therapy such as surgery, radiation cryotherapy, high-intensity focused ultrasound \[HIFU\], etc.) localized adenocarcinoma of the prostate with the following clinical findings: * Clinical stage by digital rectal exam of either T1c or T2a/b (limited to one side of the gland); (American Joint Committee on Cancer \[AJCC\], version 7) or cT1a-c or 2a or 2b * Stages T1a-T1b are eligible if patient underwent transurethral prostatic resection (TURP) * The patient must meet one of the following 3 criteria: 1) Gleason score must be Gleason 7(3+4) with a PSA \< 20 ng/mL, or 2) Gleason 6 (3+3) with a PSA \> 10 ng/mL and \< 20 ng/mL which is considered intermediate risk and eligible for the study (AJCC, version 7), or 3) Group Grade 1 with a PSA \> 10 ng/mL and \< 20 ng/mL or 2 with a PSA \< 20 ng/mL * If patient is receiving a 5-alpha reductase inhibitor at the time of enrollment, the baseline PSA value may be double the initial value and the medication should be discontinued but a washout period is not required; to be eligible, a PSA drawn while still on the medicine must be: * \< 10 ng/mL if Gleason 7(3+4) (note this patient would be on stratification level 1 if PSA \< 5 ng/mL and stratification level 2 if less than 10 ng/mL) * \> 5 ng/mL and less than 10 ng/mL for Gleason 6(3+3) (note this patient would be on stratification level 3) * The prostate volume must be \< 70 cc as reported at time of biopsy or by separate measure with ultrasound or other imaging modalities including magnetic resonance imaging (MRI) or computed tomography (CT) scan * Patients in active surveillance who elect to be treated are eligible if they meet protocol requirements * Age \>= 18 * History and physical including a digital rectal exam 60 days prior to registration * Eastern Cooperative Oncology Group (ECOG) performance status 0-1 60 days prior to registration * MRI of the prostate and pelvis (per institutional standard of care \[SOC\] - should be compliant with PIRADSv2.1 guidelines) within 1 year prior to registration * Bone scan as clinically indicated within 120 days prior to registration * Charlson modified co-morbidity score =\< 4 for patients under 60 and =\< 5 for patients 60 and over 21 days prior to registration * International prostate symptom score (IPSS) of \< 15 21 days prior to registration * The patient must provide study-specific informed consent prior to study entry * Willingness and ability to complete the Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire * Completion of all items of the EPIC-26 which will be data entered at registration 60 days prior to registration * Only English, Spanish, and French-speaking patients are eligible to participate as these are the only languages EPIC-26 has been validated in
Exclusion criteria
* Definitive clinical or radiologic evidence of metastatic disease; no nodal involvement or evidence of metastatic disease allowed as defined by screening of the pelvis * Definitive T3 disease on MRI * Prior or current invasive malignancy with current evidence of active disease within the past 2 years * Exceptions: Non-melanomatous skin cancer, carcinoma in situ of the male breast, penis, oral cavity, or stage Ta of the bladder, or stage I completely resected melanoma * Prior systemic chemotherapy for the study cancer; note that prior chemotherapy for a different cancer is allowable; must be off treatment for at least 3 years * Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields * The use of hormonal therapy is not allowed; if the patient is on a 5-alpha reductase inhibitor, then they should be stopped prior to treatment once enrolled onto the study; no washout period is required for this study to participate * Severe, active co-morbidity defined as follows: * Human immunodeficiency virus (HIV) positive with CD4 count \< 200 cells/microliter; Note that patients who are HIV positive are eligible, provided they are under treatment with highly active antiretroviral therapy (HAART) and have a CD4 count \>= 200 cells/microliter within 30 days prior to registration; Note also that HIV testing is not required for eligibility for this protocol; this exclusion criterion is necessary because the treatments involved in this protocol may be significantly immunosuppressive * Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; note, however, that laboratory tests for liver function and coagulation parameters are not required for entry into this protocol; (patients on Coumadin or other blood thinning agents are eligible for this study) * Contraindication to MRI * Cardiac pacemaker or defibrillator * Surgically implanted electrical devices such as spinal stimulation devices or intracranial stimulation devices, cochlear implants, the presence of metallic foreign bodies in the orbits, and incompatible old mechanical heart valves and aneurysm clips
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of patients-reported gastrointestinal and genitourinary toxicity | Up to 2 years | Will be measured by Expanded Prostate Cancer Index Composite-(EPIC) 26 bowel and urinary irritation domains. Will be compared between treatment arms using a test of proportions with two-sided significance level of 0.05. |
| Disease free survival | Time to biochemical failure (Phoenix definition), local failure, regional failure, distant metastasis, or death from any cause, assessed up to 2 years | Will be estimated using the Kaplan-Meier method and treatment arms compared using the stratified log-rank test. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Regional failure | From the time of randomization to the date of local failure, date of precluding death, or last known follow-up date, assessed for up to 2 years | — |
| Distant metastasis | From the time of randomization to the date of distant metastasis, date of precluding death, or last known follow-up date, assessed for up to 2 years | — |
| Prostate cancer specific survival | Up to 2 years | — |
| Overall survival | From the date of randomization to the date of death or last known follow-up date, with patients alive at the last known follow-up time treated as censored, assessed up to 5 years | Will be estimated using the Kaplan-Meier method and treatment arms compared using the stratified log-rank test. |
| Incidence of adverse events (AEs) | Up to 2 years | Will be assessed by Common Terminology Criteria for Adverse Events version 5.0. Counts of all AEs by grade will be provided by treatment arm. Counts and frequencies will be provided for the worst grade AE experienced by the patient by treatment arm. The number of patients with at least 1 grade 3 or higher AE will be compared between the treatment arms. A comparison between treatment arms of grade 3 and higher genitourinary (GU) and gastrointestinal (GI) events related to treatment (separately) will also be tested. There are 5 pre-specified AEs, dysuria, hematuria, incontinence, rectal bleeding, and fatigue. A comparison of any event and grade and higher events will be compared between treatment arms. All comparisons will be tested using a Chi-Square test with a significance level of 0.05. |
| Presence of Prostate Imaging-Reporting and Data System version (PIRADSv) 2 = 4/5 disease | Baseline | Will be assessed by magnetic resonance imaging (MRI). |
| Predictive value of PIRADSv2 = 4/5 disease for biochemical failure | Up to 2 years | Predictive value of PIRADSv2 = 4/5 disease for biochemical failure |
| Health related quality of life | Up to 2 years | Will be measured by EPIC-26 urinary incontinence, sexual, and hormonal domains. |
| Biochemical failure | Up to 2 years | Will be assessed by Phoenix definition. |
| Local failure | From the time of randomization to the date of local failure, date of precluding death, or last known follow-up date, assessed for up to 2 years | — |
Other
| Measure | Time frame | Description |
|---|---|---|
| Image registration performance | Up to 2 years | Image registration performance |
| Predictive utility of radiomic analysis | Up to 2 years | Predictive utility of radiomic analysis |
| Predictive value for local control and biochemical failure | At 2 years | Will be assessed by MRI. |
| Central manual user segmentation of tumors | Up to 2 years | Central manual user segmentation of tumors |
| Performance of supervised automated tumor segmentation toolset | Up to 5 years | Performance of supervised automated tumor segmentation toolset |
| Performance of supervised automated tumor detection toolset | Up to 2 years | Performance of supervised automated tumor detection toolset |
Countries
Canada, Hong Kong, India, Ireland, Switzerland, United States
Outcome results
None listed