- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00776100
Radiation Therapy or Observation After Chemotherapy in Treating Patients With Stage IV Non-Small Cell Lung Cancer
A Randomized Phase II Study of Oligometastatic Stage IV Non-Small Cell Lung Cancer (NSCLC) Treated With Systemic Therapy Plus Either Radiotherapy to All Sites of Gross Residual Disease or No Radiotherapy
RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Sometimes, after chemotherapy, the tumor may not need more treatment until it progresses. In this case, observation may be sufficient. It is not yet known whether radiation therapy is more effective than observation after chemotherapy in treating non-small cell lung cancer.
PURPOSE: This randomized phase II trial is studying how well radiation therapy works compared with observation after chemotherapy in treating patients with stage IV non-small cell lung cancer.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
OBJECTIVES:
Primary
- To assess whether the addition of radiotherapy to radiographically apparent residual disease after an initial course of standard chemotherapy results in an improvement in overall survival of patients with oligometastatic stage IV non-small cell lung cancer.
Secondary
- To compare the progression-free survival of patients treated with radiotherapy vs observation after standard chemotherapy.
- To compare the time to disease progression and time to treatment failure in these patients.
- To compare the confirmed response rate in these patients.
- To compare the duration of response in these patients.
- To compare the adverse events in these patients.
OUTLINE: This is a multicenter study. Patients are stratified according to prior treatment with bevacizumab during first-line chemotherapy (yes vs no), number of standard chemotherapy courses (2-3 vs 4-6), Linear Analog Self Assessment value (≤ 7 vs > 7), and histology (predominantly squamous cell vs not predominantly squamous cell). Patients are randomized to 1 of 2 treatment arms.
- Arm I: Patients undergo observation for 6 weeks.
- Arm II: Patients undergo radiotherapy 5 days a week for 6 weeks to all sites of gross disease.
After completion of study therapy, patients are followed every 3-6 months for up to 5 years.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
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Arizona
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Scottsdale, Arizona, United States, 85259-5499
- Mayo Clinic Scottsdale
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Connecticut
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Hartford, Connecticut, United States, 06105
- Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center
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Florida
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Jacksonville, Florida, United States, 32224
- Mayo Clinic - Jacksonville
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Illinois
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Bloomington%, Illinois, United States, 61701
- Illinois CancerCare - Bloomington
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Canton, Illinois, United States, 61520
- Illinois CancerCare - Canton
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Canton, Illinois, United States, 61520
- Graham Hospital
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Carthage, Illinois, United States, 62321
- Illinois CancerCare - Carthage
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Eureka, Illinois, United States, 61530
- Illinois CancerCare - Eureka
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Eureka, Illinois, United States, 61530
- Eureka Community Hospital
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Galesburg, Illinois, United States, 61401
- Illinois CancerCare - Galesburg
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Galesburg, Illinois, United States, 61401
- Galesburg Cottage Hospital
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Galesburg, Illinois, United States, 61401
- Galesburg Clinic, PC
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Galesburg, Illinois, United States, 61401
- InterCommunity Cancer Center of Western Illinois
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Havana, Illinois, United States, 62644
- Mason District Hospital
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Havana, Illinois, United States, 62644
- Illinois CancerCare - Havana
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Kewanee, Illinois, United States, 61443
- Illinois CancerCare - Kewanee Clinic
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Macomb, Illinois, United States, 61455
- Illinois CancerCare - Macomb
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Macomb, Illinois, United States, 61455
- McDonough District Hospital
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Maywood, Illinois, United States, 60153
- Cardinal Bernardin Cancer Center at Loyola University Medical Center
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Moline, Illinois, United States, 61265
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Moline, Illinois, United States, 61265
- Trinity Cancer Center at Trinity Medical Center - 7th Street Campus
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Monmouth, Illinois, United States, 61462
- Illinois CancerCare - Monmouth
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Monmouth, Illinois, United States, 61462
- OSF Holy Family Medical Center
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Normal, Illinois, United States, 61761
- BroMenn Regional Medical Center
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Normal, Illinois, United States, 61761
- Community Cancer Center
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Normal, Illinois, United States, 61761
- Illinois CancerCare - Community Cancer Center
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Ottawa, Illinois, United States, 61350
- Community Hospital of Ottawa
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Ottawa, Illinois, United States, 61350
- Oncology Hematology Associates of Central Illinois, PC - Ottawa
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Peoria, Illinois, United States, 61636
- Methodist Medical Center of Illinois
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Peoria, Illinois, United States, 61614
- Proctor Hospital
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Peoria, Illinois, United States, 61615
- CCOP - Illinois Oncology Research Association
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Peoria, Illinois, United States, 61615
- Oncology Hematology Associates of Central Illinois, PC - Peoria
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Peru, Illinois, United States, 61354
- Illinois CancerCare - Peru
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Peru, Illinois, United States, 61354
- Illinois Valley Community Hospital
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Princeton, Illinois, United States, 61356
- Perry Memorial Hospital
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Princeton, Illinois, United States, 61356
- Illinois CancerCare - Princeton
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Spring Valley, Illinois, United States, 61362
- Valley Cancer Center
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Indiana
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Beech Grove, Indiana, United States, 46107
- St. Francis Hospital and Health Centers - Beech Grove Campus
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Richmond, Indiana, United States, 47374
- Reid Hospital & Health Care Services
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Iowa
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Ames, Iowa, United States, 50010
- McFarland Clinic, PC
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Bettendorf, Iowa, United States, 52722
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Clive, Iowa, United States, 50325
- Medical Oncology and Hematology Associates - West Des Moines
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Des Moines, Iowa, United States, 50309
- CCOP - Iowa Oncology Research Association
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Des Moines, Iowa, United States, 50309
- John Stoddard Cancer Center at Iowa Methodist Medical Center
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Des Moines, Iowa, United States, 50309
- Medical Oncology and Hematology Associates at John Stoddard Cancer Center
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Des Moines, Iowa, United States, 50314
- Medical Oncology and Hematology Associates at Mercy Cancer Center
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Des Moines, Iowa, United States, 50314
- Mercy Cancer Center at Mercy Medical Center - Des Moines
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Des Moines, Iowa, United States, 50316
- John Stoddard Cancer Center at Iowa Lutheran Hospital
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Mason City, Iowa, United States, 50401
- Mercy Cancer Center at Mercy Medical Center - North Iowa
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Sioux City, Iowa, United States, 51101
- Siouxland Hematology-Oncology Associates, LLP
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Sioux City, Iowa, United States, 51104
- St. Luke's Regional Medical Center
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Sioux City, Iowa, United States, 51104
- Mercy Medical Center - Sioux City
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Kansas
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Chanute, Kansas, United States, 66720
- Cancer Center of Kansas, PA - Chanute
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Dodge City, Kansas, United States, 67801
- Cancer Center of Kansas, PA - Dodge City
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El Dorado, Kansas, United States, 67042
- Cancer Center of Kansas, PA - El Dorado
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Fort Scott, Kansas, United States, 66701
- Cancer Center of Kansas - Fort Scott
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Independence, Kansas, United States, 67301
- Cancer Center of Kansas-Independence
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Kingman, Kansas, United States, 67068
- Cancer Center of Kansas, PA - Kingman
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Lawrence, Kansas, United States, 66044
- Lawrence Memorial Hospital
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Liberal, Kansas, United States, 67901
- Southwest Medical Center
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Newton, Kansas, United States, 67114
- Cancer Center of Kansas, PA - Newton
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Parsons, Kansas, United States, 67357
- Cancer Center of Kansas, PA - Parsons
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Pratt, Kansas, United States, 67124
- Cancer Center of Kansas, PA - Pratt
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Salina, Kansas, United States, 67401
- Cancer Center of Kansas, PA - Salina
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Topeka, Kansas, United States, 66606
- Cotton-O'Neil Cancer Center
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Wellington, Kansas, United States, 67152
- Cancer Center of Kansas, PA - Wellington
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Wichita, Kansas, United States, 67214
- Wesley Medical Center
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Wichita, Kansas, United States, 67208
- Cancer Center of Kansas, PA - Medical Arts Tower
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Wichita, Kansas, United States, 67214
- Cancer Center of Kansas, PA - Wichita
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Wichita, Kansas, United States, 67214
- CCOP - Wichita
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Wichita, Kansas, United States, 67214
- Via Christi Cancer Center at Via Christi Regional Medical Center
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Wichita, Kansas, United States, 67208
- Associates in Womens Health, PA - North Review
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Winfield, Kansas, United States, 67156
- Cancer Center of Kansas, PA - Winfield
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Massachusetts
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Burlington, Massachusetts, United States, 01805
- Lahey Clinic Medical Center - Burlington
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Michigan
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Ann Arbor, Michigan, United States, 48106-0995
- Saint Joseph Mercy Cancer Center
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Ann Arbor, Michigan, United States, 48106
- CCOP - Michigan Cancer Research Consortium
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Dearborn, Michigan, United States, 48123-2500
- Oakwood Cancer Center at Oakwood Hospital and Medical Center
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Flint, Michigan, United States, 48503
- Hurley Medical Center
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Flint, Michigan, United States, 48503
- Genesys Hurley Cancer Institute
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Grosse Pointe Woods, Michigan, United States, 48236
- Van Elslander Cancer Center at St. John Hospital and Medical Center
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Jackson, Michigan, United States, 49201
- Foote Memorial Hospital
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Lansing, Michigan, United States, 48912-1811
- Sparrow Regional Cancer Center
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Livonia, Michigan, United States, 48154
- St. Mary Mercy Hospital
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Pontiac, Michigan, United States, 48341-2985
- St. Joseph Mercy Oakland
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Port Huron, Michigan, United States, 48060
- Mercy Regional Cancer Center at Mercy Hospital
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Saginaw, Michigan, United States, 48601
- Seton Cancer Institute at Saint Mary's - Saginaw
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Warren, Michigan, United States, 48093
- St. John Macomb Hospital
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Minnesota
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Bemidji, Minnesota, United States, 56601
- MeritCare Bemidji
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Burnsville, Minnesota, United States, 55337
- Fairview Ridges Hospital
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Coon Rapids, Minnesota, United States, 55433
- Mercy and Unity Cancer Center at Mercy Hospital
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Edina, Minnesota, United States, 55435
- Fairview Southdale Hospital
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Fridley, Minnesota, United States, 55432
- Mercy and Unity Cancer Center at Unity Hospital
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Hutchinson, Minnesota, United States, 55350
- Hutchinson Area Health Care
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Maplewood, Minnesota, United States, 55109
- Minnesota Oncology Hematology, PA - Maplewood
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Maplewood, Minnesota, United States, 55109
- HealthEast Cancer Care at St. John's Hospital
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Minneapolis, Minnesota, United States, 55407
- Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
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Minneapolis, Minnesota, United States, 55415
- Hennepin County Medical Center - Minneapolis
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Robbinsdale, Minnesota, United States, 55422-2900
- Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center
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Rochester, Minnesota, United States, 55905
- Mayo Clinic Cancer Center
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Saint Louis Park, Minnesota, United States, 55416
- CCOP - Metro-Minnesota
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Saint Louis Park, Minnesota, United States, 55416
- Park Nicollet Cancer Center
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Saint Paul, Minnesota, United States, 55102
- United Hospital
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Shakopee, Minnesota, United States, 55379
- St. Francis Cancer Center at St. Francis Medical Center
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St. Paul, Minnesota, United States, 55101
- Regions Hospital Cancer Care Center
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Waconia, Minnesota, United States, 55387
- Ridgeview Medical Center
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Woodbury, Minnesota, United States, 55125
- Minnesota Oncology Hematology, PA - Woodbury
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Mississippi
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Jackson, Mississippi, United States, 39216
- University of Mississippi Cancer Clinic
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Missouri
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Saint Louis, Missouri, United States, 63131
- Missouri Baptist Cancer Center
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Saint Louis, Missouri, United States, 63141
- Arch Medical Services, Incorporated at Center for Cancer Care and Research
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Springfield, Missouri, United States, 65802
- CCOP - Cancer Research for the Ozarks
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Springfield, Missouri, United States, 65804
- St. John's Regional Health Center
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Springfield, Missouri, United States, 65807
- Hulston Cancer Center at Cox Medical Center South
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Montana
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Billings, Montana, United States, 59101
- CCOP - Montana Cancer Consortium
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Billings, Montana, United States, 59101
- Hematology-Oncology Centers of the Northern Rockies - Billings
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Billings, Montana, United States, 59101
- Northern Rockies Radiation Oncology Center
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Billings, Montana, United States, 59101
- St. Vincent Healthcare Cancer Care Services
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Billings, Montana, United States, 59107-7000
- Billings Clinic - Downtown
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Bozeman, Montana, United States, 59715
- Bozeman Deaconess Cancer Center
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Butte, Montana, United States, 59701
- St. James Healthcare Cancer Care
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Great Falls, Montana, United States, 59405
- Great Falls Clinic - Main Facility
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Great Falls, Montana, United States, 59405
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Great Falls, Montana, United States, 59405-5309
- Big Sky Oncology
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Great Falls, Montana, United States, 59405
- Sletten Cancer Institute at Benefis Healthcare
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Havre, Montana, United States, 59501
- Northern Montana Hospital
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Helena, Montana, United States, 59601
- St. Peter's Hospital
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Kalispell, Montana, United States, 59901
- Kalispell Regional Medical Center
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Kalispell, Montana, United States, 59901
- Glacier Oncology, PLLC
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Kalispell, Montana, United States, 59901
- Kalispell Medical Oncology at KRMC
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Missoula, Montana, United States, 59801
- Community Medical Center
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Missoula, Montana, United States, 59804
- Guardian Oncology and Center for Wellness
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Missoula, Montana, United States, 59807-7877
- Montana Cancer Specialists at Montana Cancer Center
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Missoula, Montana, United States, 59807
- Montana Cancer Center at St. Patrick Hospital and Health Sciences Center
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North Carolina
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Goldsboro, North Carolina, United States, 27534
- Wayne Memorial Hospital, Incorporated
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Hendersonville, North Carolina, United States, 28791
- Pardee Memorial Hospital
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North Dakota
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Bismarck, North Dakota, United States, 58501
- Bismarck Cancer Center
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Bismarck, North Dakota, United States, 58501
- Medcenter One Hospital Cancer Care Center
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Bismarck, North Dakota, United States, 58501
- Mid Dakota Clinic, PC
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Bismarck, North Dakota, United States, 58502
- St. Alexius Medical Center Cancer Center
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Fargo, North Dakota, United States, 58122
- CCOP - MeritCare Hospital
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Fargo, North Dakota, United States, 58122
- MeritCare Broadway
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Grand Forks, North Dakota, United States, 58201
- Altru Cancer Center at Altru Hospital
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Ohio
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Dayton, Ohio, United States, 45405
- Grandview Hospital
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Dayton, Ohio, United States, 45406
- Good Samaritan Hospital
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Dayton, Ohio, United States, 45409
- David L. Rike Cancer Center at Miami Valley Hospital
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Dayton, Ohio, United States, 45415
- Samaritan North Cancer Care Center
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Dayton, Ohio, United States, 45420
- CCOP - Dayton
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Findlay, Ohio, United States, 45840
- Blanchard Valley Medical Associates
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Franklin, Ohio, United States, 45005-1066
- Middletown Regional Hospital
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Greenville, Ohio, United States, 45331
- Wayne Hospital
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Kettering, Ohio, United States, 45429
- Charles F. Kettering Memorial Hospital
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Troy, Ohio, United States, 45373-1300
- UVMC Cancer Care Center at Upper Valley Medical Center
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Wilmington, Ohio, United States, 45177
- Clinton Memorial Hospital
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Wright-Patterson Afb, Ohio, United States, 45433-5529
- United States Air Force Medical Center - Wright-Patterson
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Xenia, Ohio, United States, 45385
- Ruth G. McMillan Cancer Center at Greene Memorial Hospital
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Oklahoma
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Tulsa, Oklahoma, United States, 74136
- Natalie Warren Bryant Cancer Center at St. Francis Hospital
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Oregon
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Milwaukie, Oregon, United States, 97222
- Providence Milwaukie Hospital
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Portland, Oregon, United States, 97216
- Adventist Medical Center
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Portland, Oregon, United States, 97213-2967
- Providence Cancer Center at Providence Portland Medical Center
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Portland, Oregon, United States, 97225
- CCOP - Columbia River Oncology Program
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Portland, Oregon, United States, 97225
- Providence St. Vincent Medical Center
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South Dakota
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Sioux Falls, South Dakota, United States, 57105
- Medical X-Ray Center, PC
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Sioux Falls, South Dakota, United States, 57117-5039
- Sanford Cancer Center at Sanford USD Medical Center
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Tennessee
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Kingsport, Tennessee, United States, 37662
- Christine LaGuardia Phillips Cancer Center at Wellmont Holston Valley Medical Center
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Virginia
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Danville, Virginia, United States, 24541
- Danville Regional Medical Center
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Washington
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Vancouver, Washington, United States, 98668
- Southwest Washington Medical Center Cancer Center
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Wisconsin
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La Crosse, Wisconsin, United States, 54601
- Franciscan Skemp Healthcare - La Crosse Campus
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Wyoming
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Casper, Wyoming, United States, 82609
- Rocky Mountain Oncology
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Sheridan, Wyoming, United States, 82801
- Welch Cancer Center at Sheridan Memorial Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
DISEASE CHARACTERISTICS:
Histologically or cytologically confirmed non-small cell lung cancer (NSCLC)
- Mixed histology allowed if all components are consistent with NSCLC
- Squamous cell histology allowed
Stage IV disease
Oligometastatic disease (M1 with 1-3 metastases)
- Patients with M1 disease that involves intrapulmonary metastases are eligible provided ≤ 40% of the total lung volume receives ≥ 20 Gy of radiotherapy
- Previously untreated disease OR achieved stable disease or partial response within 8 weeks after completion of 2-6 courses of standard platinum-based chemotherapy (administered every 3-4 weeks)
- Pleural effusion allowed provided it is minimal
No history of or current brain metastases
- Patients who have had up to 3 brain metastases allowed provided they have been treated with not signs of progression
PATIENT CHARACTERISTICS:
- ECOG performance status 0-1
- Life expectancy ≥ 12 weeks
- Platelet count ≥ 100,00/mm^3
- Hemoglobin ≥ 9 g/dL
- WBC ≥ 2,000/mm^3
- Creatinine ≤ 2 times upper limit of normal
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Able to undergo radiotherapy, based on radiation oncology consultation
- Willing and able to comply with study treatment
- FEV_1 ≥ 1 L
- No requirement for daily supplemental oxygen
No second primary malignancy, except for any of the following:
- Carcinoma in situ of the cervix
- Nonmelanoma skin cancer
- History of low-grade (Gleason score ≤ 6) localized prostate cancer, even if diagnosed within the past 5 years
- Stage I breast cancer that was treated within the past 5 years
- Other malignancy that was diagnosed and definitely treated ≥ 5 years ago with no subsequent evidence of recurrence
No concurrent severe and/or uncontrolled medical condition, including any of the following:
- Angina pectoris
- Congestive heart failure within the past 3 months, unless LVEF > 40%
- Myocardial infarction within the past 6 months
- Cardiac arrhythmia
- No clinically significant infection
- No psychiatric illness or social situation that would limit compliance with study requirements
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- No prior therapy for this cancer other than 2-6 courses of standard platinum-based chemotherapy with or without bevacizumab
- No prior radiotherapy to the treatment sites (e.g., primary lesion, clinically involved nodes, or metastatic lesions)
- No bevacizumab during and for 4 weeks after completion of radiotherapy
- No concurrent systemic chemotherapy
- No other maintenance systemic therapy during radiotherapy
- No other concurrent investigational agents for the primary neoplasm
- No concurrent intensity modulated radiotherapy
- No concurrent prophylactic nodal radiotherapy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Other: Arm I
Patients undergo observation for 6 weeks.
|
Patients undergo observation for 6 weeks.
|
|
Experimental: Arm II
Patients undergo radiotherapy 5 days a week for 6 weeks to all sites of gross disease.
|
Patients undergo radiotherapy 5 days a week for 6 weeks.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Overall Survival
Time Frame: Time from registration to death or last follow-up (up to 5 years)
|
Overall survival was defined as the time from registration to the date of death or last follow-up
|
Time from registration to death or last follow-up (up to 5 years)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Response Rate
Time Frame: Up to 5 years
|
A confirmed tumor response was defined as a complete response (CR) or partial response (PR) noted as the objective status on 2 consecutive evaluations around 3 months apart.
All participants with measurable disease (non-CR at baseline, etc.), meeting the eligibility criteria who have signed a consent form and have started the study were evaluable for response.
|
Up to 5 years
|
|
Progression-free Survival
Time Frame: Time from registration to disease progression or death (up to 5 years)
|
Progression-free survival was defined as the time from randomization to the first of either death due to any cause or progression.
|
Time from registration to disease progression or death (up to 5 years)
|
|
Time to Disease Progression
Time Frame: Time from registration to disease progression (up to 5 years)
|
Time to disease progression was defined as the time from randomization to the earliest date documentation of disease progression occurs.
If a patient dies without a documentation of disease progression, the patient will be considered to have had tumor progression at the time of their death unless there is sufficient documented evidence to conclude no progression occurred prior to death.
|
Time from registration to disease progression (up to 5 years)
|
|
Time to Treatment Failure
Time Frame: Up to 5 years
|
Time to treatment failure was defined as the time from the date of randomization to the date at which the patient was removed from treatment (Arm II) or no treatment (Arm I) due to progression, adverse events, or refusal.
|
Up to 5 years
|
|
Duration of Response
Time Frame: Up to 5 years
|
Duration of response was defined for all evaluable patients who have achieved an objective response as the date at which the patient's earliest best objective status was first noted to be either a complete response (CR) or partial response (PR) to the earliest date progression was documented.
|
Up to 5 years
|
Collaborators and Investigators
Collaborators
Investigators
- Study Chair: Steven E. Schild, MD, Mayo Clinic
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- NCCTG-N0724
- NCI-2009-00664 (Registry Identifier: CTRP (Clinical Trials Reporting System))
- CDR0000616868 (Registry Identifier: PDQ (Physician Data Query))
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.