Non-small Cell Lung Cancer
Conditions
Keywords
Non-small cell lung cancer, MR-Linac, Fractionated stereotactic radiation therapy, Brain metastase
Brief summary
This Phase II study is to determine the efficacy and safety of MR-Linac Guided Adaptive fractionated stereotactic radiotherapy (FSRT) in patients with brain metastases in non-small cell lung cancer.
Detailed description
This Phase II study is to determine the efficacy and safety of MR-Linac Guided Adaptive fractionated stereotactic radiotherapy (FSRT) in patients with brain metastases in non-small cell lung cancer. Patients will receive FSRT (30Gy in 5 fractions) on the MR-Linac treatment machine. The primary end point is 1-year intracranial progression-free survival. The secondary end points are objective response rate, 1-y PFS, 1-y OS, perilesional edema of brain metastases, quality of life, safety of treatment, dose coverage of targets and dose to normal organs.
Interventions
COMBINATION_PRODUCTUnity-based MR-Linac guided FSRT
The FSRT was delivered using the Unity-based MR-Linac treatment machine, with a total dose of 30Gy in 5 fractions.
Sponsors
Sun Yat-sen University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Aged 18-75 years * Histologically or cytologically confirmed non-small cell lung cancer * 1-10 metastases on contrast-enhanced MRI * Radiotherapy for extracranial lesions is permitted * Tyrosine kinase inhibitors (TKI) are permitted in patients with progression of intracranial metastases during previous TKI therapy * Patients have measurable or evaluable lesions based on the Response Evaluation Criteria in Solid Tumors (RECIST) criteria * Eastern Cooperative Oncology Group (ECOG) performance status 0-1 * Normal function of organs and bone marrow within 14 days: Total bilirubin 1.5 times or less the upper limits of normal (ULN); AST and ALT 1.5 times or less the ULN; absolute neutrophil count≥ 500 cells/mm3; creatinine clearance rate(CCR) ≥45 mL/min; Platelet count≥50,000 cells/mm3; international normalized ratio(INR) ≤1.5#Prothrombin Time (PT)≤ 1.5 × ULN * Informed-consent
Exclusion criteria
* Small cell carcinoma of lung * Intracranial metastases needed surgical decompression * Patients with contraindications for MRI * Previous radiotherapy or excision for intracranial metastases * The tumor has completely approached, encircled, or invaded the intravascular space of the great vessels (e.g., the pulmonary artery or the superior vena cava) * A cavity over 2cm in diameter of primary tumor or metastasis * Bleeding tendency or coagulation disorder * Hemoptysis (1/2 teaspoon blood/day) happened within 1 month * The use of full-dose anticoagulation within the past 1 month * Severe vascular disease occurred within 6 months * Gastrointestinal fistula, perforation or abdominal abscess occurred within 6 months * Hypertensive crisis, hypertensive encephalopathy, symptomatic heart failure (New York class II or above), active cerebrovascular disease or cardiovascular disease occurred within 6 months * Uncontrolled hypertension (systolic \> 150mmHg and/or diastolic \> 100mmHg) * Major surgery within 28 days or minor surgery or needle biopsy within 48 hours * Urine protein 3-4+, or 24h urine protein quantitative \>1g * Severe uncontrolled disease * Uncontrollable seizure or psychotic patients without self-control ability * Women in pregnancy, lactation period * Other not suitable conditions determined by the investigators
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1-year intracranial progression-free survival | 1 year |
Secondary
| Measure | Time frame |
|---|---|
| Objective response rate | 2 months |
| 1-year progression-free survival | 1 year |
| 1-year overall survival | 1 year |
| Rate of participants with perilesional edema of brain metastases evaluated byT2-weighted MRI | 1 year |
| Quality of life evaluated by EORTC quality of life questionnaire | 1 year |
| Rate of patients with treatment-related adverse events evaluated by CTCAE v4.0 | 1 year |
| Dose coverage to targets | 2 months |
| Dose to normal organs | 2 months |
Countries
China
Outcome results
None listed