- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04310891
Markerless Image Guidance Using Intrafraction Kolovoltage X-ray Imaging for Lung Cancer Radiotherapy (VALKIM)
Validation of Markerless Image Guidance Using Intrafraction Kolovoltage X-ray Imaging Using Implanted Fiducials: Phase I Observational Study of Lung Cancer Radiotherapy
Study Overview
Status
Intervention / Treatment
Detailed Description
We will perform a phase I observational trial investigating the feasibility of the Markerless Tumour Tracking technology. Markerless Tumour Tracking will be integrated with existing treatment machines to provide real-time monitoring of tumour motion during treatment delivery. Eligible patients are implanted with fiducial markers, which act as the ground truth for evaluating the accuracy of Markerless Tumour Tracking. The patients will undergo the current standard of care radiotherapy, with the exception that kilovoltage x-ray images will be acquired continuously during treatment delivery and used to calculate online Markerless Tumour Tracking. Markerless Tumour Tracking determines the mean tumour position calculated over the most recent 15 seconds and displays shifts exceeding 3 mm.
The trial will be a single-institution study recruiting only at RNSH Radiation Oncology Department.
As this trial investigates feasibility, our focus will be on estimating the proportion of treatment time in which the Markerless Tumour Tracking is within acceptable limits.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Carol Kwong, RN
- Phone Number: 31339 +61294631339
- Email: carolyn.kwong@health.nsw.gov.au
Study Contact Backup
- Name: Heidi Tsang, RN
- Phone Number: 31340 +61294631340
- Email: heidi.tsang@health.nsw.gov.au
Study Locations
-
-
New South Wales
-
Saint Leonards, New South Wales, Australia, 2065
- Recruiting
- Royal North Shore Hospital
-
Contact:
- Heidi Tsang, RN
- Phone Number: 31340 +61294631340
- Email: heidi.tsang@health.nsw.gov.au
-
Contact:
- Carol Kwong, RN
- Phone Number: 31339 +61 29463 1339
- Email: carolyn.kwong@health.nsw.gov.au
-
Principal Investigator:
- Dasantha Jayamanne, MBBS/FRANZCR
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Aged 18 or older.
- Has provided written Informed Consent for participation in this trial and is willing to comply with the study.
- Patients undergoing external beam radiotherapy.
- Histologically proven Stage I NSCLC or oligometastatic lung metastases (3 or less).
- Diagnostic CT prior to insertion of fiducial markers.
- Patient must be able to have fiducial markers placed in the lung (if on anticoagulants, must be cleared by LMO or cardiologist).
- ECOG performance status 0-2.
- A maximum of three metastases to the lung from any non-haematological malignancy. Multiple metastases will be treated separately.
- 1 cm ≤ Tumour diameter in any dimension ≤ = 5 cm.
- The distance between the tumour centroid and the top end of the diaphragm is <=8 cm.
Exclusion Criteria:
- Patient has low respiratory performance as evaluated by the physicians.
- Previous high-dose thoracic radiotherapy.
- Less than one fiducial marker implanted in the lung.
- Fiducial markers are too far from the tumour centroid (>9 cm).
- Cytotoxic chemotherapy within 3 weeks of commencement of treatment, or concurrently with treatment. Hormonal manipulation agents are allowable (e.g. aromatase inhibitors, selective oestrogen receptor modulators, and gonadotropin releasing hormone receptor modulators).
- Targeted agents (such as sunitinib, bevacizumab and tarceva) within 7 days of commencement of treatment, concurrently with treatment or 7 days after radiotherapy.
- Women who are pregnant or lactating.
- Unwilling or unable to give informed consent.
- Unwilling or unable to complete quality of life questionnaires.
Study Plan
How is the study designed?
Design Details
- Observational Models: Cohort
- Time Perspectives: Prospective
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Markerless
Markerless Tumour Tracking will be used to observe the radiation beam is accurately targeting the tumour.
|
Intrafraction Kolovoltage X-ray Imaging using Fiducials
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Markerless Tumour Tracking
Time Frame: 6 months after recruitment
|
to demonstrate the feasibility of Markerless Tumour Tracking for motion-adaptive lung cancer radiotherapy as assessed by agreement between markerless and marker-based tracking within 3 mm for at least 80% of the beam-on time as assessed in off-line analyses.
|
6 months after recruitment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Markerless Tumour Tracking outcome
Time Frame: 6 months after treatment of last fraction
|
To identify cohort of patients on which markerless Tumour tracking performs well or poorly
|
6 months after treatment of last fraction
|
Accuracy
Time Frame: 6 months after treatment of last fraction
|
To quantify the accuracy of marker-based tracking by comparison with MV-kV triangulation or visual inspection
|
6 months after treatment of last fraction
|
Magnitude
Time Frame: 6 months after treatment of last fraction
|
To investigate the magnitude of surrogacy of lung tumour motion, ie the difference between tumour motion and implanted marker motion
|
6 months after treatment of last fraction
|
Correlation
Time Frame: 6 months after treatment of last fraction
|
To investigate the correlation between external and internal motion using infrared/optical imaging
|
6 months after treatment of last fraction
|
Suitability
Time Frame: 6 months after treatment of last fraction
|
To investigate the suitability and frequency of correcting for tumour baseline shifts based on a variety of tolerance criteria and with different methods
|
6 months after treatment of last fraction
|
Frequency
Time Frame: 6 months after treatment of last fraction
|
To investigate the frequency of correcting for tumour baseline shifts based on a variety of tolerance criteria and with different methods
|
6 months after treatment of last fraction
|
Feasibility of outcomes prediction
Time Frame: 6 months after treatment of last fraction
|
To investigate the feasibility of predicting treatment outcomes based on patient and imaging information
|
6 months after treatment of last fraction
|
Outcomes
Time Frame: 6 months after treatment of last fraction
|
Participants will be followed for 2 years to determine patient outcomes, including radiation therapy toxicity, local control (whether the tumour has spread) and survival
|
6 months after treatment of last fraction
|
Historical
Time Frame: 6 months after treatment of last fraction
|
2 year outcomes will be compared to historical outcomes reported from our lung Departmental SBRT database
|
6 months after treatment of last fraction
|
Ineligibility
Time Frame: 6 months after treatment of last fraction
|
To record the number of patients ineligible after marker insertion due to positioning of markers, or due to complications with the implantation procedure
|
6 months after treatment of last fraction
|
Radiomic Features
Time Frame: 6 months after treatment of last fraction
|
To investigate the feasibility of extracting radiomic features from CT, CBCT, and kV images to predict tumour volumes, tracking accuracy, treatment response, and patient outcomes.
|
6 months after treatment of last fraction
|
X-ray dose
Time Frame: 6 months after treatment of last fraction
|
To report additional x-ray dose caused by imaging during treatment
|
6 months after treatment of last fraction
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Dasantha Jayamanne, MD, Royal North Shore Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- VALKIM
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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