Short-term High Precision Radiotherapy for Early Prostate Cancer With Concomitant Boost on the Dominant Lesion

June 27, 2023 updated by: European Institute of Oncology
The present research project aims to improve the current treatment for prostate-confined tumor, evaluating the safety and feasibility of a very short hypofractionated radiotherapy schedule administered with one of the best available dose delivery systems. The study will include 2 sub-studies (in-silica and clinical study) and 4 tasks.

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Detailed Description

Approximately 70% of men with newly diagnosed prostate cancer feature organ-confined disease. Conventional treatment options for prostate-confined cancer include radical prostatectomy, external beam radiation therapy, brachytherapy and active surveillance. All currently available treatments have comparable toxicity risk and high social and economic impact, hence the best treatment option has not been defined yet. In the radiation oncology field the gold standard for prostate cancer management is 7-8 weeks intensity modulated radiotherapy (IMRT), which can be delivered with the latest generation of accelerators providing modulated arc delivery (eg. RapidArc™, Varian) or with newly developed machines such as the Vero system (BrainLab AG - Mitsubishi Heavy Industries Ltd). The present research project aims to improve the current treatment for prostate confined tumor, evaluating the best strategy to deliver a very-short hypofractionated radiotherapy scheme. In the first part of this AIRC grant an in-silica study will be performed on 10 test prostate cancer patients, with comparative competitive treatment plans with the state of the art treatment options for prostate cancer: the Vero system, the RapidArc system, the Cyberknife (all available at the European Institute of Oncology IEO, Milan, Italy), and protontherapy (available at the Centre of Adrotherapy, in Pavia, Italy). This dosimetric comparison will be performed in order to define the technique that provides the maximum target coverage with the minimum dose to the surrounding organs at risk (OARs) to be used to perform the clinical trial that will follow within this AIRC grant. After performing the in-silica study, 65 newly diagnosed prostate cancer patients with 2011 National Comprehensive Cancer Network (NCCN) risk category ranging from very low to intermediate but not undergoing hormonal treatment, will be consecutively enrolled in a prospective phase II trial. The patients will be treated at the Division of Radiation Oncology of the IEO, with the dose delivery system that will result most fit at the in-silica study. Simultaneous Integrated Boost (SIB) technique will be applied to deliver a total dose of 36.25 Gy in 5 fractions (over 10 days) to the whole prostate (7.25 Gy/fraction) and 37.5 Gy to the dominant intraprostatic lesion DIL (7.5 Gy/fraction), profiting of the high sensibility of prostate cancer to high dose/fraction. Several strategies will be applied in order to reduce the dose to the surrounding OARs. In order to define the localization of the DIL, multiparametic magnetic resonance imaging (MRI) of the pelvis will be performed (with spectroscopy, diffusion weighted and perfusion acquisitions), and fused with computed tomography (CT) scan. In-room image-guidance will be applied at each treatment section, in order to minimize uncertainties in intra and inter-fraction prostate localization. At the end of the radiotherapy course, each patient will be followed-up, in order to assess the treatment safety and effectiveness in terms of early and late toxicity, and tumor control. A sampling from the prostate tumor tissue for biological study will be taken for microarray analysis. The expression of specific markers of radiosensitivity and radioresistance will be investigated.

Study Type

Interventional

Enrollment (Estimated)

65

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Italy
      • Milan, Italy
        • European Institute of Oncology

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

- Histologically confirmed adenocarcinoma of prostate, including the following 2011 National Comprehensive Cancer Network (NCCN) risk categories: very low (T1c PSA <10 ng/ml, Gleason score <7, fewer than 3 positive biopsy cores, <50% cancer in each core, PSA density <0.15 ng/ml) or low (T1-T2a, PSA <10 ng/ml, Gleason score <7) or intermediate (T2b or T2c, PSA between 10 and 20 ng/ml, Gleason score of 7)

  • cN0 and cM0 stage
  • Age > 18 years
  • Good performance status (ECOG< 2),
  • No previous pelvic radiotherapy
  • No previous prostatectomy
  • No hormonal treatment (neoadjuvant or concomitant)
  • No concomitant bowel inflammatory disease or other serious comorbidities
  • Good urinary flow (peak flow > 10 ml/s)
  • No previous invasive cancer (within 5 years before the prostate cancer diagnosis) apart from non-melanoma skin malignancies.

Exclusion Criteria:

  • Extraprostatic tumor extension (T3) or locally advanced disease (T4)
  • Pelvic lymph node metastasis (N1)
  • Distant metastasis (M1)
  • Urinary obstructive symptoms (IPSS > 20)
  • Previous pelvic radiotherapy
  • Severe systemic disorders
  • Concomitant disorders including: chronic urinary or intestinal inflammatory conditions (for example, ulcerous recto-colitis, Crohn disease), anti-coagulant treatment (warfarin, heparin)
  • Previous malignancy except for skin non-melanoma cancer or 3-year disease free interval from previous malignancy like in situ cervix cancer or non muscle invasive bladder cancer
  • Non conformity of the radiotherapy dose distribution when compared to the dose constraints
  • Psychiatric disorders or any other condition that can can make unreliable the informed consent

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: External beam radiotherapy
Radiation: External beam radiotherapy
The patients will be treated with extreme hypofractionated radiotherapy with the dose delivery system that will result most fit at the in-silica study. Simultaneous Integrated Boost (SIB) technique will be applied to deliver a total dose of 36.25 Gy in 5 fractions (over 10 days) to the whole prostate (7.25 Gy/fraction) and 37.5 Gy to the dominant intraprostatic lesion DIL (7.5 Gy/fraction), profiting of the high sensibility of prostate cancer to high dose/fraction. Several strategies will be applied in order to reduce the dose to the surrounding organs at risk.
Other Names:
  • hypofractionated radiotherapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Acute toxicity
Time Frame: one month after radiotherapy
The primary outcome is the acute toxicity according to the validated scale Radiotherapy Oncology Group / European Organization for Research and Treatment of Cancer (RTOG / EORTC). It will measure the proportion of patients who experience at least one event of acute toxicity of grade 3 or 4 according to the scale RTOG / EORTC) as the maximum value of toxicity during radiation treatment or within one month after the completion of radiotherapy.
one month after radiotherapy

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
late toxicity
Time Frame: 2 years
late toxicity according to Scala CTCAE v4.0 toxicity criteria and scale RTOG / EORTC
2 years
efficacy of treatment
Time Frame: 2 years

assessed in terms of

  • biochemical progression free survival (biochemical relapse, i.e. rising PSA)
  • pattern of relapse
  • clinical progression free survival (including local or distant recurrence)
  • overall survival
2 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

European Institute of Oncology

Investigators

  • Principal Investigator: Roberto Orecchia, MD, European Institute of Oncology
  • Principal Investigator: BARBARA A JERECZEK, MD PhD, European Institute of Oncology

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2014

Primary Completion (Actual)

July 1, 2017

Study Completion (Estimated)

July 1, 2023

Study Registration Dates

First Submitted

July 30, 2013

First Submitted That Met QC Criteria

July 31, 2013

First Posted (Estimated)

August 1, 2013

Study Record Updates

Last Update Posted (Actual)

June 28, 2023

Last Update Submitted That Met QC Criteria

June 27, 2023

Last Verified

June 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IEO S768/113
  • 2012-IG133218 (Other Grant/Funding Number: AIRC)

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.

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