Radiation Therapy in Treating Patients With Hepatocellular Carcinoma, Cholangiocarcinoma, or Liver Metastasis Who Have Impaired Liver Function

Phase I Trial of Radiation Therapy in Patients With Liver Cancers and Impaired Liver Function

This phase I trial studies the side effects and the best dose of radiation therapy in treating patients with hepatocellular carcinoma, cholangiocarcinoma, or cancer that has spread from the original (primary) tumor to the liver who also have impaired liver function (liver damage caused by cirrhosis, chemotherapy, or surgery). Radiation therapy (RT) uses high energy x-rays to kill tumor cells and shrink tumors. New methods of giving RT to the liver may help control cancer.

Study Overview

• Status: Active, not recruiting
• Conditions: Hepatocellular Carcinoma; Cirrhosis; Cholangiocarcinoma; Metastatic Malignant Neoplasm in the Liver
• Intervention / Treatment: Other: Laboratory Biomarker Analysis; Other: Survey Administration; Radiation: Radiation Therapy; Procedure: Magnetic Resonance Imaging

Detailed Description

PRIMARY OBJECTIVES:

I. To evaluate the safety of high dose radiotherapy in patients who have liver tumors (hepatocellular carcinoma [HCC]/cholangiocarcinoma/liver metastases from any primary) and who have impaired liver function or low functional liver volume or who have received prior liver radiation.

SECONDARY OBJECTIVES:

I. To evaluate 2 year local control with radiotherapy in these patients. II. To evaluate tumor response, patterns of failure, and survival in these patients.

III. To evaluate imaging- and serum-based biomarkers in these patients, as correlates of hepatic toxicity and tumor response.

OUTLINE: This is a dose-escalation study.

Patients undergo radiation therapy 5 days a week for a total of 15 or 25 fractions in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up at 4-8 weeks and then every 3-4 months for 2 years. Patients who progress during the two year follow-up period are followed up every 6 months.

• Study Type: Interventional
• Enrollment (Actual): 36
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • M D Anderson Cancer Center

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Diagnosis of hepatocellular carcinoma, cholangiocarcinoma, or liver metastasis from any histology
• Patients may have single or multinodular tumors
• There is no specific tumor size cut-off for this protocol; however, the radiation treatment plan must meet the protocol's dose constraints

• Compromised liver function as defined by any of the following:

  • Cohort 1: Advanced cirrhosis group

    • Borderline Child-Pugh class A6

    • Child-Pugh class B

      • The patients in this advanced cirrhosis group must have at least 400 ml of functional liver, as estimated on either diagnostic imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) or single photon emission computed tomography (SPECT)/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients

  • Cohort 2: Low functional liver volume without underlying chronic liver disease

    • Previous irinotecan or oxaliplatin chemotherapy

    • Previous liver resection(s)

      • These patients must have at least 400 ml of functional liver, as estimated by either diagnostic imaging computed tomography or magnetic resonance imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients;

  • Cohort 3: History of prior liver-directed radiation therapy with either fractionated external beam radiation therapy (EBRT), stereotactic body radiation therapy (SBRT) or yttrium-90 radioembolization (Y90 RE); the interval between prior EBRT and re-irradiation on protocol should be equal to or greater than 12 months; the interval between prior Y90 RE and re-irradiation on protocol should be equal to or greater than 6 months;

    • Cirrhosis group:

      • Child-Pugh class A5;
      • Borderline Child-Pugh class A6;
      • The patients in this group must have at least 400 ml of functional liver, as estimated on either diagnostic imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients

  • Low functional liver volume without underlying liver disease

    • Previous irinotecan or oxaliplatin chemotherapy
    • Previous liver resection(s)
    • These patients must have at least 400 ml of functional liver, as estimated by either diagnostic imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2
• Women of childbearing potential (those who have not undergone a hysterectomy or who have not been postmenopausal for at least 24 consecutive months) must agree to practice adequate contraception and to refrain from breast feeding
• Prior history of surgical resection, chemotherapy, transarterial chemoembolization (TACE), and/or radiofrequency ablation are allowed
• Expected survival must be greater than 3 months
• Patients may receive concurrent capecitabine or sorafenib at the discretion of the treating physicians
• Signed study-specific consent form

Exclusion Criteria:

• Prior liver-directed radiation therapy in cohort 1 (advanced cirrhosis group) or cohort 2 (low functional volume group)
• Prior yttrium-90 therapy for patients in cohorts 1 or 2
• Patients with a Child-Pugh score less than 6 or greater than 9 for radiation naive patients with cirrhosis (cohort 1)
• Child-Pugh score of greater than 6 for patients with cirrhosis who previously received liver directed radiation (EBRT or Y90 RE) (cohort 3)
• Unstable angina and/or symptomatic congestive heart failure requiring hospitalization within the last 6 months; transmural myocardial infarction within the last 6 months prior to study entry
• Current evidence of fever or untreated infection
• Active hepatitis, including but not limited to viral and drug-induced
• Poorly controlled inflammatory bowel disease
• Women with a positive pregnancy test
• Inability to comply with study and/or follow-up procedures
• Patients with an active second malignancy or prior invasive malignancy unless disease free for a minimum of 3 years; non-melanoma skin cancer and previous early prostate cancer that had a non-rising prostate-specific antigen (PSA) can be enrolled

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

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Treatment (radiation therapy); Patients undergo radiation therapy 5 days a week for a total of 15 or 25 fractions in the absence of disease progression or unacceptable toxicity.

Other: Laboratory Biomarker Analysis; Correlative studies; Other: Survey Administration; Ancillary studies; Radiation: Radiation Therapy; Undergo radiation therapy; Other Names: Cancer Radiotherapy; Irradiate; Irradiated; Radiation; Radiotherapeutics; RT; Therapy, Radiation; irradiation; RADIOTHERAPY; Procedure: Magnetic Resonance Imaging; Correlative studies; Other Names: MRI; Magnetic Resonance Imaging Scan; Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance; MRI Scan; NMR Imaging; NMRI; Nuclear Magnetic Resonance Imaging

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maximum dose constraint	Defined as the highest level dose constraint at which no more than 1 of 6 evaluable patients has had a dose limiting toxicity. Toxicities will be summarized with frequency by type, severity and their relationship to the treatment.	4-8 weeks after completion of radiation therapy

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Local disease control rate	The Kaplan Meier method will be used to estimate 2-year local disease control rate.	Up to 2 years
Tumor response	Will be observed.	Up to 2 years
Patterns of failure	Will be observed.	Up to 2 years
Overall survival	The Kaplan Meier method will be used to estimate the probability of overall survival.	Up to 2 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tumor biomarker expression in serum	Imaging- and serum-based biomarkers will be correlated with hepatic toxicity and tumor response. Plots such as box plot and scatter plots will be used to evaluate expressions of markers between patients with and without response, and between patients having experienced DLTs and patients having not experienced DLTs, and Wilcoxon rank sum test will be used to compare expressions of markers between these patients.	Baseline

Collaborators and Investigators

• Sponsor: M.D. Anderson Cancer Center
• Collaborators: National Cancer Institute (NCI)
• Investigators: Principal Investigator: Eugene J Koay, M.D. Anderson Cancer Center

Publications and helpful links

General Publications

• Chang E, Wong FCL, Chasen BA, Erwin WD, Das P, Holliday EB, Koong AC, Ludmir EB, Minsky BD, Noticewala SS, Smith GL, Taniguchi CM, Rodriguez MJ, Beddar S, Martin-Paulpeter RM, Niedzielski JS, Sawakuchi GO, Schueler E, Perles LA, Xiao L, Szklaruk J, Park PC, Dasari AN, Kaseb AO, Kee BK, Lee SS, Overman MJ, Willis JA, Wolff RA, Tzeng CD, Vauthey JN, Koay EJ. Phase I trial of single-photon emission computed tomography-guided liver-directed radiotherapy for patients with low functional liver volume. JNCI Cancer Spectr. 2024 Apr 30;8(3):pkae037. doi: 10.1093/jncics/pkae037.
• Chang E, Holliday EB, Szklaruk J, Erwin WD, Ludmir EB, Noticewala SS, Das P, Koong AC, Minsky BD, Smith GL, Sawakuchi GO, Martin-Paulpeter RM, Niedzielski JS, Perles LA, Beddar S, Valino VS, Nguyen JL, Raghav KPS, Javle M, Kaseb AO, Dasari AN, Overman MJ, Parseghian CM, Odisio BC, Mahvash A, Kuban JD, Shen SE, Wang XS, Gupta AC, Al Taie MM, Brock KK, Tzeng CD, Vauthey JN, Wong FCL, Koay EJ. Single-photon emission computed tomography functional liver imaging to facilitate reirradiation for liver malignancies: A phase I trial. JHEP Rep. 2026 Apr;8(4):101743. doi: 10.1016/j.jhepr.2026.101743. Epub 2026 Jan 22.

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2016
• Primary Completion (Estimated): April 28, 2028
• Study Completion (Estimated): April 28, 2028

Study Registration Dates

• First Submitted: December 7, 2015
• First Submitted That Met QC Criteria: December 7, 2015
• First Posted (Estimated): December 10, 2015

Study Record Updates

• Last Update Posted (Actual): April 30, 2026
• Last Update Submitted That Met QC Criteria: April 29, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Neoplasms by Site; Neoplasms; Neoplasms by Histologic Type; Digestive System Neoplasms; Digestive System Diseases; Liver Diseases; Neoplasms, Glandular and Epithelial; Adenocarcinoma; Liver Neoplasms; Carcinoma; Pathological Conditions, Signs and Symptoms; Carcinoma, Hepatocellular; Fibrosis; Cholangiocarcinoma; Investigative Techniques; Therapeutics; Physical Phenomena; Chemistry Techniques, Analytical; Spectrum Analysis; Radiotherapy; Radiation; Magnetic Resonance Spectroscopy
• Other Study ID Numbers: 2015-0052 (Other Identifier: M D Anderson Cancer Center); P30CA016672 (U.S. NIH Grant/Contract); NCI-2016-00006 (Registry Identifier: CTRP (Clinical Trial Reporting Program))

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No