CyberKnife Radiosurgical Treatment of Inoperable Early Stage Non-Small Cell Lung Cancer

A Prospective Evaluation of Outcomes of Radiosurgical Treatment of Early Stage Non-Small Cell Lung Cancer (NSCLC)

The purpose of this study is to assess the short and long-term outcomes after CyberKnife stereotactic radiosurgery for early stage non-small cell lung cancer (NSCLC) in patients who are medically inoperable.

Study Overview

• Status: Unknown
• Conditions: Non-small Cell Lung Cancer
• Intervention / Treatment: Radiation: CyberKnife Stereotactic Radiosurgery

Detailed Description

The objectives of this clinical evaluation are to assess the outcomes of patients who undergo stereotactic radiosurgery (SRS) to treat primary early stage non-small cell lung cancer (NSCLC) in patients (comprising of two cohorts, peripheral and central) who are not candidates for surgical resection because of high operative risks. In particular, the effect of CyberKnife SRS on clinical response rate, local control, progression-free survival, overall survival, dyspnea and QOL (for U.S. sites), and radiological findings over two years after treatment will be evaluated.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Phase 2

Contacts and Locations

Study Locations

• China
  • Tianjin, China, 300060
    • Tianjin Medical University Cancer Institution and Hospital
  • Guangxi
    • Nanning, Guangxi, China, 530011
      • Ruikang Hospital
• United States
  • Arizona
    • Phoenix, Arizona, United States, 85013
      • St Joseph's Hospital/Barrow Neurological Institute
  • California
    • Fresno, California, United States, 93721
      • Community Regional Medical Center
    • Palo Alto, California, United States, 94305
      • Stanford University
  • Colorado
    • Colorado Springs, Colorado, United States, 80907
      • Penrose Cancer Center
    • Lone Tree, Colorado, United States, 80124
      • Denver CyberKnife
  • Florida
    • Gainesville, Florida, United States, 32605
      • North Florida Radiation Oncology
    • Naples, Florida, United States, 34102
      • Naples Community Hospital
  • Illinois
    • Arlington Heights, Illinois, United States, 60005
      • Northwest Community Hospital
    • Oak Lawn, Illinois, United States, 60453
      • Advocate Christ Med Center
  • Indiana
    • Fort Wayne, Indiana, United States, 46845
      • Parkview Cancer Center
    • Munster, Indiana, United States, 46321
      • St. Catherine's Hospital
  • Kentucky
    • Lexington, Kentucky, United States, 40503
      • Central Baptist Hospital
  • Maryland
    • Baltimore, Maryland, United States, 21215
      • Sinai Hospital of Baltimore
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • St. Louis University Hospital
  • Nevada
    • Reno, Nevada, United States, 89503
      • St. Mary's Regional Medical Center
  • Oklahoma
    • Oklahoma City, Oklahoma, United States, 73101
      • St. Anthony's Hospital
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15213
      • University of Pittsburgh
  • Texas
    • Dallas, Texas, United States, 75204
      • Baylor Research Institute
    • Houston, Texas, United States, 77030
      • St. Luke's Episcopal Hospital
  • Washington
    • Tacoma, Washington, United States, 98405
      • MultiCare Health System
  • Wisconsin
    • Milwaukee, Wisconsin, United States, 53215
      • Aurora St. Luke's Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Patient must be over the age of 18 years
2. Pulmonary nodule with maximum diameter ≤ 5 cm
3. Histological confirmation of primary NSCLC

4. The following stage of NSCLC patients are eligible:

   • Stage I: T1 N0 M0 or T2 N0 M0 (Tumor size ≤ 5 cm)
   • Stage II: T3 N0 M0 (Chest wall invasion only, Tumor size ≤ 5 cm)
5. ECOG/Zubrod status of 0, 1 or 2
6. Thoracic surgery consultation should be obtained from a Board Certified Thoracic surgeon who in collaboration with a radiation oncologist should determine that the patient is not a surgical candidate.

7. In order to be considered medically inoperable, the patient must meet at least one major criteria or a minimum of 2 minor criteria as described below:

   MAJOR CRITERIA:

   1. FEV1 < 50% or predicted postoperative FEV1 < 40%
   2. DLCO < 50% or predicted postoperative DLCO < 40%
   3. Exercise induced maximal exercise oxygen consumption M VO2 < 15 mL/kg/min

   4. High-risk cardiac disease: Any one of the following:

      • Poor left ventricular function (defined as an ejection fraction of <=20%)
      • Unstable coronary syndromes (unstable angina or severe angina Canadian class III or IV).
      • Severe valvular disease (critical valvular stenosis),
      • Recent myocardial infarction (< 1 month),
      • Significant arrhythmia defined by one of the following: High-grade AV block, Symptomatic ventricular arrhythmias in the presence of underlying heart disease, Supraventricular arrhythmias with uncontrolled ventricular rate

   MINOR CRITERIA:

   1. Age > 75
   2. Pulmonary hypertension (defined as a pulmonary artery systolic pressure greater than 40 mm Hg)
   3. Oxygen requirement (using the Medicare criteria for home oxygen requirements [i.e., room air oxygen saturation of 88% or less])
   4. Resting or exercise arterial pO2 ≤ 55 mm Hg OR SpO2 ≤ 88%.
   5. pCO2 > 45 mm Hg
   6. Congestive heart failure (any three of the following must be documented: dyspnea, peripheral edema, chest x-ray with interstitial edema or cardiomegaly, rales, or congestion)
   7. Moderately depressed left ventricular function (defined as an ejection fraction of 21-40% or less)
   8. Severe cerebral (with CVA or recent TIA) or severe peripheral vascular disease
   9. Diabetes Mellitus with severe organ damage such as ESRD, Blindness, Vascular disease.
   10. Severe end organ damage from other causes resulting in ESRD, cirrhosis of the liver or vascular disease
   11. FEV1 51%-60% or predicted postoperative FEV1 41-50%
   12. DLCO 51-60% or predicted postoperative DLCO 41-50%
   13. Modified Medical Research Council Dyspnea Scale ≥ grade 3
8. Females of child-bearing age must be using a reliable form of birth control.
9. The patient must have a PET-CT scan within 8 weeks of registration.
10. The patient must provide a signed and dated written informed consent PRIOR to registration and prior to undergoing any study-related procedures.
11. The patient must provide written authorization to allow the use and disclosure of their protected health information.

Exclusion Criteria:

1. Excluding the primary cancer targeted for this treatment, the patient has a prior history of cancer (within the last 5 years) or concurrent cancer other than basal cell or squamous skin cancer.
2. Visible endobronchial lesion seen in the trachea, carina, major bronchus, lobar or segmental bronchus on bronchoscopy or microscopic disease detected in the trachea, carina, major bronchus, lobar or segmental bronchus.
3. The patient's weight exceeds the tolerances of the institution's imaging and CyberKnife platform/couch.
4. The patient has received thoracic radiation therapy in the same field as the planned treatment area in the past.
5. The patient has completed chemotherapy within less than 30 days of treatment.
6. T2: Tumor size > 5 cm, T3 tumors (except T3 by virtue of chest wall invasion and ≤ 5 cm), T4 tumors. Presence of N1, N2 or N3 disease per previously described criteria would be excluded.
7. Pancoast tumors would be excluded.
8. Current distant metastatic disease (M1) (preferably biopsy proven).
9. The patient is a female with child-bearing potential who refuses to take a pregnancy test prior to treatment.
10. The patient is pregnant or a female who is nursing an infant.
11. The patient is planning on undergoing systemic therapy within 2 weeks after the last fraction of radiation
12. The patient has an active systemic or pulmonary infection.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

EXPERIMENTAL: CyberKnife Stereotactic Radiosurgery

Radiation: CyberKnife Stereotactic Radiosurgery; Central tumors defined as < 2 cm from carina and < 2 cm from right and left mainstem bronchus and/or < 2 cms from the right and left upper lobe bronchus, bronchus intermedius, middle lobe bronchus, and the right and left lower lobe bronchus. For central tumors, 4 fractions of 12 Gy will be delivered (12 Gy x 4 fractions = 48 Gy) Peripheral tumors are defined as being > 2 cms from the carina and > 2 cms from the right and left mainstem bronchus and/or > 2 cms from the right and left upper lobe bronchus, bronchus intermedius, middle lobe bronchus and the right and left lower lobe bronchus. For peripheral tumors, 3 fractions of 20 Gy will be delivered (20 Gy x 3 fractions = 60 Gy); Other Names: CyberKnife; Radiation Therapy; Radiosurgery; Stereotactic Radiosurgery

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Local progression-free survival, local disease progression, clinical response rate, regional recurrence-free survival, distant recurrence-free survival.	5 years

Secondary Outcome Measures

Outcome Measure	Time Frame
To characterize and compare quality of life before and after stereotactic radiosurgery treatment. To assess procedure-related outcomes after stereotactic radiosurgery of lung tumors.	5 years

Collaborators and Investigators

• Sponsor: Accuray Incorporated
• Collaborators: University of Pittsburgh
• Investigators: Study Chair: James Luketich, MD, University of Pittsburgh Medical Center

Publications and helpful links

Helpful Links

• Accuray Website

Study record dates

Study Major Dates

• Study Start: April 1, 2006
• Primary Completion (ANTICIPATED): December 1, 2021
• Study Completion (ANTICIPATED): December 1, 2021

Study Registration Dates

• First Submitted: March 20, 2008
• First Submitted That Met QC Criteria: March 20, 2008
• First Posted (ESTIMATE): March 26, 2008

Study Record Updates

• Last Update Posted (ACTUAL): March 5, 2021
• Last Update Submitted That Met QC Criteria: March 3, 2021
• Last Verified: August 1, 2019

More Information

Terms related to this study

• Keywords: NSCLC; lung cancer; non-small cell lung cancer; radiosurgery; CyberKnife; lung surgery; lung tumor
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Neoplasms; Lung Diseases; Neoplasms by Site; Respiratory Tract Neoplasms; Thoracic Neoplasms; Carcinoma, Bronchogenic; Bronchial Neoplasms; Lung Neoplasms; Carcinoma, Non-Small-Cell Lung
• Other Study ID Numbers: ACCL001.0