Monitoring of Patients Treated With Particle Therapy Using Positron-Emission-Tomography (PET): The MIRANDA Study (MIRANDA)

Monitoring of Patients Treated With Particle Therapy Using Positron-Emission-Tomography (PET): The MIRANDA Study.

The purpose of this clinical study is to investigate the clinical feasibility and effectiveness of off-line Positron-Emission-Tomography (PET) quality assurance for promoting the accuracy of proton and carbon ion beam therapy. One main clinical advantage of ion therapy over conventional radiation therapy is the excellent conformation of the delivered dose to the tumour volume while well sparing the surrounding healthy tissue. However, clinical exploitation of this potential to the maximum extent requires in-vivo validation of the actual treatment delivery and, in particular, of the ion beam range within the patient. Since the primary ions are completely stopped in the target volume as opposed to photon radiation, no conventional quality assurance techniques like transmission electronic portal imaging can be applied to monitor ion beam therapy. Hence, ion treatment planning currently relies on models and experimental data accurately validated in tissue-equivalent targets, but no direct verification of the actual treatment delivery and of the ion beam range within the patient is possible in standard clinical practice.

At present, PET offers the unique possibility to monitor the precision of ion irradiation in-vivo and non-invasively. The method is based on the detection of the b+-activity which is formed as a by-product of the irradiation, i.e. without administration of radio-tracers to the patient. A positive clinical impact of in-beam (i.e. during the irradiation) PET monitoring has been demonstrated for carbon ion therapy in the pilot project at GSI Darmstadt, Germany, and promising clinical data of post-radiation PET/CT imaging have been recently reported for passive proton beam delivery in USA and Japan. Therefore, a pilot clinical study is hereby proposed at the Heidelberg Ion Therapy Center in order to 1) assess the applicability of post-radiation PET imaging to scanned ion beam delivery, 2) identify the patient population which may benefit from it and 3) extract population-based information on the reliability of the beam range in different tumour locations for all the ion species clinically available at HIT.

The investigated patients are expected to benefit from this study, since in case of detected deviations between planned and actual treatment delivery a proper correction could be applied in the next irradiation fraction, assuring an overall better treatment than without any monitoring. Moreover, site-specific patient-population information on the ion range precision at HIT might enable improvement of the CT-range calibration curve as well as safe reduction of the treatment margins to promote enhanced treatment plan conformality for full clinical exploitation of the promises of ion beam therapy.

Study Overview

• Status: Withdrawn
• Conditions: Particle Therapy

• Study Type: Observational

Contacts and Locations

Study Locations

• Germany
  • Heidelberg, Germany, 69120
    • Department of Radiation Oncology

Participation Criteria

Eligibility Criteria

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

• Sampling Method: Non-Probability Sample

Study Population

Patients treated with Particle Therapy at the Heidelberg Ion Therapy (HIT) Center will be included and grouped into 8 anatomical regions: Brain, Skull base, Head-and-neck, Upper GI, Lower GI, Prostate, Pelvic region and other.

Description

Inclusion Criteria

• The patient is treated at the Heidelberger Ionenstrahl Therapiezentrum (HIT) with protons or carbon ions.
• During the radiotherapeutic treatment patient positioning is verified using validated radiological imaging such as cone beam CT, X-ray or conventional CT (Reference-Imaging as described above).
• The patient is at least 18 years of age and is able to give informed consent.
• The patient has been informed about the aims and the content of the study.

Exclusion Criteria

• No informed consent to take part in the study.
• Medical reasons that impair the patients from being in the supine position for the data acquisition time, e.g. pain.
• Non-compliance of the patient.

Study Plan

How is the study designed?

Number of groups / cohorts

8

Cohorts and Interventions

Group / Cohort
Other
Prostate
Skull Base
Lower GI
Pelvic Region
Head-and-Neck
Upper GI
Brain

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
TBA	TBA	TBA

Collaborators and Investigators

• Sponsor: University Hospital Heidelberg
• Investigators: Principal Investigator: Stephanie E Combs, MD, University Hospital of Heidelberg

Publications and helpful links

General Publications

• Combs SE, Bauer J, Unholtz D, Kurz C, Welzel T, Habermehl D, Haberer T, Debus J, Parodi K. Monitoring of patients treated with particle therapy using positron-emission-tomography (PET): the MIRANDA study. BMC Cancer. 2012 Apr 3;12:133. doi: 10.1186/1471-2407-12-133.

Study record dates

Study Major Dates

• Study Start (Anticipated): May 1, 2019
• Primary Completion (Anticipated): May 1, 2022
• Study Completion (Anticipated): May 1, 2022

Study Registration Dates

• First Submitted: December 30, 2011
• First Submitted That Met QC Criteria: February 7, 2012
• First Posted (Estimate): February 8, 2012

Study Record Updates

• Last Update Posted (Actual): May 17, 2018
• Last Update Submitted That Met QC Criteria: May 11, 2018
• Last Verified: May 1, 2018

More Information

Terms related to this study

• Other Study ID Numbers: MIRANDA