Stereotactic Body Radiation Therapy in Treating Patients With Liver Cancer That Cannot Be Removed by Surgery
A Pilot Study of Stereotactic Liver Irradiation for Hepatocellular Carcinoma
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate feasibility and safety of stereotactic body radiation therapy (SBRT) of the liver for treatment of hepatocellular carcinoma (HCC).
SECONDARY OBJECTIVES:
I. To evaluate radiographic local response, local control and time to local progression (TTLP) of treated lesions in HCC patients after liver SBRT.
II. To evaluate overall survival (OS) and cancer specific survival (CSS) in HCC patients treated with liver SBRT.
III. To evaluate explanted irradiated liver tissue (for patients who proceed to liver transplantation) to determine extent of residual tumor and extent of radiation effects within and around the irradiated field.
OUTLINE:
Patients undergo SBRT every other day over 2 weeks (5 fractions total) in the absence of unacceptable toxicity.
After completion of study treatment, patients are followed up at 1, 3, 6, 9, and 12 months and then every 6 months for up to 2 years.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
New York
-
The Bronx, New York, United States, 10461
- Albert Einstein College Of Medicine
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Life expectancy > 3 months
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2
HCC diagnosed by either of the following approaches:
- Histologic confirmation of HCC on biopsy
- Evidence of vascular enhancement of suspected lesion on at least two imaging techniques
- Evidence of vascular enhancement on a single technique if the alpha-fetoprotein (AFP) is > 200 ng/mL in the setting of cirrhosis or chronic hepatitis B/C
HCC must be deemed unresectable by an experienced surgeon or patient must be medically inoperable or extra-hepatic metastases must be present (making resection an inappropriate treatment option) or patient must have declined the option of surgery after consultation with a surgeon
- Barcelona Clinic Liver Cancer score of B or C required (i.e., intermediate or advanced stage HCC)
- Prior liver resection or ablative therapy is permitted
- Prior transarterial chemoembolization (TACE) is permitted
- Patients must have recovered from the effects of previous therapy
- Maximal tumor size of 15 cm and > 700 cc of uninvolved liver
- Hemoglobin > 9.0 g/L
- Absolute neutrophil count >= 1.0 bil/L
- Platelets >= 70,000 bil/L
- Total bilirubin < 2 mg/dL
- International normalized ratio (INR) =< 1.5 or correctable with vitamin K (higher INR acceptable if patient is on Coumadin)
- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 6 times upper range of normal
Exclusion Criteria:
- Active hepatitis or encephalopathy related to liver failure
- Prior radiation therapy to the upper abdomen or thorax
- Lesions within 1 cm from the stomach
- Prior uncontrolled, life threatening malignancy within the previous 6 months
- Pregnancy is not permitted; women of child-bearing age must undergo pregnancy testing prior to enrollment
- Previous gastric, duodenal or variceal bleed within the past 2 months
- Thrombolytic therapy within 4 weeks or commencement of anticoagulant use within the past 3 months
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Treatment (SBRT)
Patients undergo SBRT every other day over 2 weeks (5 fractions total) in the absence of unacceptable toxicity.
|
Undergo SBRT
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Severe Treatment-related Toxicity
Time Frame: Within 3 months of SBRT
|
The percentage of patients who have severe treatment-related toxicity will be computed, along with exact 95% confidence intervals.
Severe toxicity will be defined as grade 4 or 5 hepatic toxicity, thrombocytopenia, or gastrointestinal toxicity, graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0
|
Within 3 months of SBRT
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Cancer Specific Survival (CSS)
Time Frame: Time from study entry to death from Hepatocellular Carcinoma (HCC) progression, assessed up to 2 years
|
Cancer Specific Survival (CSS) was assessed in patients who were diagnosed with HCC and treated with liver SBRT as the percentage of patients with Cause-Specific Death from HCC. Patients alive at the end of the follow-up period were censored.
Competing risk analysis was performed.
|
Time from study entry to death from Hepatocellular Carcinoma (HCC) progression, assessed up to 2 years
|
|
Overall Survival (OS)
Time Frame: Time from study entry to death from any cause, assessed up to 2 years
|
Overall Survival, estimated using the Kaplan-Meier method, reflected the percentage of patients who were were diagnosed with HCC and started SBRT treatment and were still alive at the conclusion of the study.
|
Time from study entry to death from any cause, assessed up to 2 years
|
|
Time to Local Progression (TTLP) of Treated Lesions
Time Frame: From date of first treatment dose to the first date of objective local progressive disease as defined by RECIST criteria, assessed up to 2 years
|
Time to Local progression (TTLP) of treated lesions in HCC patients after liver SBRT treatment was evaluated using Response Evaluation Criteria In Solid Tumors Criteria (RECIST).
For patients who died from the study disease without progression of the radiated lesion, time to local progression was censored at the date of death.
For patients not known to have died as of the data cut-off date, and who did not have locally progressive disease, time to local progression was censored at the last progression-free disease assessment.
|
From date of first treatment dose to the first date of objective local progressive disease as defined by RECIST criteria, assessed up to 2 years
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Nitin Ohri, Albert Einstein College Of Medicine
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Neoplasms by Site
- Neoplasms
- Neoplasms by Histologic Type
- Digestive System Neoplasms
- Digestive System Diseases
- Liver Diseases
- Neoplasms, Glandular and Epithelial
- Adenocarcinoma
- Liver Neoplasms
- Carcinoma
- Carcinoma, Hepatocellular
- Investigative Techniques
- Therapeutics
- Surgical Procedures, Operative
- Radiotherapy
- Stereotaxic Techniques
- Neurosurgical Procedures
- Radiosurgery
Other Study ID Numbers
Other Study ID Numbers
- 2010-326 (Other Identifier: Albert Einstein College of Medicine)
- P30CA013330 (U.S. NIH Grant/Contract)
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