- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06330909
Image-guided Focal Dose Escalation- Primary pc Treated With Primary External Beam Hypofract.Stereotactic rt (HypoF-SBRT)
Image-guided Focal Dose Escalation in Patients With Primary Prostate Cancer Treated With Primary External Beam Hypofractionated Stereotactic Radiation Therapy (HypoFocal-SBRT) - a Prospective, Multicenter, Randomized Phase III Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Prostate cancer (PCa) is the most frequent diagnosed malignancy in male patients in Europe and radiation therapy (RT) is a main treatment option. Conventional RT for patients with primary PCa aims at delivering a homogeneous dose to the entire prostatic gland. However, recent studies proved that modern medical imaging is able to detect accurately the intraprostatic tumour mass (ITM). Consequently, RT concepts for PCa have an imminent need to be rectified in order to individualize the RT strategy by considering the individual tumor localization. In addition, the radiobiological characteristics of the major organs at risk, the rectum and urinary bladder / urethra, as well as of the PCa itself speak for clear advantages of hypofractionated radiation therapy. High-precision stereotactic body radiation therapy (SBRT) significantly shortens the duration of treatment, with clear implications for quality of life and socio-economic aspects.
The aim of this prospective, randomized, multicenter phase III study is the personalization of RT for patients with primary PCa based on individual tumor geometry derived from modern imaging techniques (mpMRI and PSMA-PET/CT). In the experimental (arm A) simultaneous RT dose escalation to the ITM will be performed under strict adherence to the organs at risks' dose constraints by using SBRT (ultra-hypofractionated radiation therapy) in a shorter treatment time (5 fractions vs. 20 fractions). In the control arm (arm B) the entire prostatic gland will receive a homogeneous moderately hypofractionated RT according to the current guidelines. RFS after RT (calculated from randomization) will be assessed as the primary endpoint as well as toxicities and patient reported quality of life as secondary endpoints. For the patients in the experimental arm we expect a significant benefit in relapse free survival (from 80% to 90% at 5 years). The improvement in relapse free survival could increase the metastatic free survival, prostate cancer survival and overall survival in high risk PCa patients. Considering the epidemiological importance of the PCa these results could have a significant socio-economic impact. In parallel a translational research program will address the identification of novel biomarkers/bio-imaging-markers predictive for outcome after RT. Furthermore, involvement of patient representatives includes information about the studies status and contributes to patient empowerment. These aspects will facilitate the evolution from an individualized RT to a personalized RT.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Sabine Schneider-Fuchs, DR
- Phone Number: +4976127074040
- Email: sabine.schneider-fuchs@uniklinik-freiburg.de
Study Contact Backup
- Name: Sonja Adebahr, MD
- Phone Number: +4976127095200
- Email: sonja.adebahr@uniklinik-freiburg.de
Study Locations
-
-
Baden-Württemberg
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Freiburg, Baden-Württemberg, Germany, 79106
- Recruiting
- Medical Center - University Of Freiburg
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Histologically confirmed adenocarcinoma of the prostate (histological confirmation can be based on tissue taken at any time, but a re-biopsy should be considered if the biopsy is more than 12 months old)
Primary localized PCa (cN0 and cM0 in mpMRI and PSMA PET):
- high- or very high-risk according to NCCN v2.2021 (see 20.3) OR
- unfavorable intermediate-risk disease according to NCCN v2.2021 (see 20.3)
- Signed, written informed consent for HypoFocal-SBRT study
- Age > 18 years
- Previously conducted PSMA-PET/CT and mpMRI scans or PSMA-PET/MR, fulfilling standard requirements for PCa (see also 6.5)
- ECOG Performance score 0 or 1
- IPSS Score ≤15
- Prostate volume ≤75 ml at RT planning
Exclusion Criteria:
- Evidence of neuroendocrine tumor cells
- Prior radiotherapy to the prostate or pelvis
- Prior radical prostatectomy
- Prior focal therapy approaches to the prostate
- Time gap between the beginning of ADT and conduction of mpMRI and PSMA PET scans is >1 month
- Radiologically suspicious or pathologically confirmed lymph node involvement (cN+) in mpMRI and/or PSMA PET/CT
- Evidence of metastatic disease (cM+) in mpMRI and/or PSMA PET/CT
- Evidence of cT4 disease in mpMRI or PSMA PET/CT
- PSA >30 ng/ml prior to starting ADT
- Expected patient survival <5 years
- Bilateral hip prostheses or any other implants/hardware that would introduce substantial CT artefacts
- Contraindication to undergo a mpMRI scan
- Prostate surgery (TURP or HOLEP) with a significant tissue cavity or prostate surgery (TURP or HOLEP) within the last 6 months prior to randomization
- Medical conditions likely to make radiotherapy inadvisable e.g. acute inflammatory bowel disease, hemiplegia or paraplegia
- Previous malignancy within the last 2 years (except basal cell carcinoma or squamous cell carcinoma of the skin), or if previous malignancy is expected to significantly compromise 5 year survival
- Any other contraindication to external beam radiotherapy (EBRT) to the pelvis
- In mpMRI and PSMA PET/CT or PSMA PET/MRI scans no visible tumor
- Participation in any other interventional clinical trial within the last 30 days before the start of this trial
- Simultaneous participation in other interventional trials which could interfere with this trial; simultaneous participation in registry and diagnostic trials is allowed
- Patient without legal capacity who is unable to understand the nature, significance and consequences of the trial;
- Known or persistent abuse of medication, drugs or alcohol
- Patients expected to have severe set up problems
- Dose constraints for organs at risk cannot be adhered to
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 |
---|---|
Experimental: Arm A - IMRT/IGRT/SBRT
Prostate and seminal vesicles RT with 30 Gy in 6 Gy / fraction; prostate RT with 35 Gy in 7 Gy / fraction including a simultaneous integrated boost (SIB) on the intraprostatic tumour mass (ITM) with 40- 42 Gy in 8 - 8.4 Gy / fraction. If the boost volume is ≥10 ml and/ or ≥ 1/3 of the prostate, the SIB on the ITM has to be restrained to 40 Gy in 8 Gy / fraction. SBRT will be performed twice a week, with at least 2 days between two RT fractions, 5 fractions in 3 weeks (technique: IMRT/IGRT/SBRT). |
technique: IMRT/IGRT/SBRT The HypoFocal-SBRT study combines ultra-hypofractionated RT / stereotactic body RT (reduction of treatment time) with a focal RT dose escalation on intraprostatic tumor sides by applying state of the art diagnostic imaging and most modern RT concepts.
Other Names:
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Active Comparator: Arm B - IMRT/IGRT
Prostate and seminal vesicles RT with 46.4 Gy in 2.32 Gy per fraction, prostate RT with 60 and 62 Gy in 3 and 3.1 Gy per fraction for unfavorable intermediate-risk and high-risk patients, respectively, 20 fractions, 5 fractions /week, (technique: IMRT/IGRT).
|
technique: IMRT/IGRT Moderate hypofractionated RT (MHRT), one option for the curative primary treatment of PCa, which has been proven by several prospective trials and is recommended and carried out worldwide.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Relapse free survival
Time Frame: 7 years
|
Primary endpoint is relapse free survival (RFS), defined as time from randomization to relapse or death.
Relapse free survival times will be censored at the time see last alive without relapse.
Analysis will be conducted after finalization of the study.
|
7 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to local failure after randomization
Time Frame: 7 years
|
Time to local failure after randomization.
Local recurrences have to be confirmed by biopsy
|
7 years
|
Metastatic free survival after randomization
Time Frame: 7 years
|
Metastatic free survival after randomization (all metastases have to be confirmed by imaging, preferably PSMA-PET/CT or mpMR imaging)
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7 years
|
Overall (OS) and prostate cancer specific (PCSS) survival after randomization
Time Frame: 7 years
|
Overall (OS) and prostate cancer specific (PCSS) survival after randomization
|
7 years
|
Time to biochemical failure (phoenix definition) after randomization
Time Frame: 7 years
|
Time to biochemical failure (phoenix definition) after randomization
|
7 years
|
Patient reported acute quality of life (QOL) - Expanded Prostate Index Composite-26 (EPIC-26)
Time Frame: at months 3 and 6 after randomization
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Patient reported acute quality of life (QOL).
Acute QOL will be assessed with the Expanded Prostate Index Composite-26 (EPIC-26) Short Form and International Prostate Symptom Score (IPSS) questionnaires at the following time points: before treatment (baseline), last day of treatment, FU visits at months 3 and 6 after randomization
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at months 3 and 6 after randomization
|
Patient reported late quality of life (QOL)
Time Frame: up to 90 after randomization
|
Patient reported late quality of life (QOL).
Late QOL will be assessed with the Expanded Prostate Index Composite-26 (EPIC-26) Short Form and International Prostate Symptom Score (IPSS) questionnaires at the following time points: FU visits at months 9,12,15,18 21, 24, 30, 36, 42, 48 and months 54, 60, 66, 72, 78, 84 up to 90 after randomization
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up to 90 after randomization
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Cumulative acute GU and GI toxicities during and up to 3 months after RT using the CTCAEv5.0 criteria
Time Frame: up to 3 months
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Cumulative acute GU and GI toxicities during and up to 3 months after RT using the CTCAEv5.0 criteria
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up to 3 months
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Cumulative Chronic GU and GI toxicities after RT using the CTCAEv5.0 criteria
Time Frame: 7 years
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Cumulative Chronic GU and GI toxicities after RT using the CTCAEv5.0 criteria
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7 years
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Dose constraints and prescription doses / recruited patients
Time Frame: 7 years
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Feasibility and adherence to dose constraints by measuring the ratio between: number of patients with fulfilled dose constraints and prescription doses / recruited patients
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7 years
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Characterization of safety: adverse events
Time Frame: 7 years
|
Characterization of safety: adverse events
|
7 years
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Study Chair: Anca-Ligia Grosu, Prof., Medical Center- University of Freiburg
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 (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
- P003103
- DRKS00022915 (Other Identifier: Deutsches Register Klinische Studien)
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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