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A Phase II Study of Extended Field IMRT External Beam Irradiation and Intracavitary Brachytherapy

18 juillet 2016 mis à jour par: Washington University School of Medicine

A Phase II Study of Extended Field IMRT External Beam Irradiation and Intracavitary Brachytherapy With Concurrent Weekly Cisplatin in Patients With Stage I-IVA Cervical Cancer Who Have FDG PET Positive Pelvic or Para-Aortic Lymph Nodes

Recent studies have shown that the chance of survival among women with advanced cervical cancer is increased when they receive concurrent chemotherapy and radiation to the pelvis. However, patients who have advanced disease show loco-regional failure as well as a high incidence of distant metastasis. Positron emission tomography (PET) scanning has high sensitivity and specificity in the detection of pelvic and para-aortic lymph node metastases. While the detection of para-aortic metastases by PET significantly impacts prognosis, PET has been known to show positive lymph node metastasis in the pelvis only while not detecting micrometastatic disease in the para-aortic lymph nodes (despite the fact that they are histologically known).

In addition, patients with positive para-aortic lymph nodes on PET, greater amounts (more than 45 Gy) of radiation must be used to improve the probability of controlling the cancer. However, doses greater than this have been limited because of the dose and volume limits to the small bowel. But, Intensity Modulated Radiation Therapy (IMRT) is a new way of calculating and delivering radiation therapy. Compared to external beam radiation, IMRT has the improved ability to deliver large doses of radiation to specific targets while minimizing the exposure to surrounding normal tissue.

With IMRT, however, the effective dose/volume can be increased more safely and lower the toxicity of surrounding tissue, thus making prophylactic dosing to para-aortic lymph nodes not detected by PET safer and more effective.

Aperçu de l'étude

Statut

Résilié

Les conditions

Intervention / Traitement

Description détaillée

Prior to entrance on the study, patients will undergo a history and physical and evaluation of Karnofsky Performance Status. They will have a biopsy of their tumor and will undergo a fluorodeoxyglucose (FDG) PET scan and must include evaluation of para-aortic lymph nodes. Blood work will be done (complete blood count (CBC), differential, platelets, blood urea nitrogen(BUN), serum creatinine, bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase. Also, pre-treatment, patients will receive a chest x-ray and an intravenous push (IVP) (unless a computed tomography (CT) with contrast has been performed). Additionally, patient may undergo a CT, magnetic resonance (MRI) and/or lymphangiogram.

Patients will then be registered to a treatment arm, depending on the outcome of their PET scan. Patients with positive pelvic lymph nodes but no positive para-aortic lymph nodes by PET will be assigned to Treatment Arm 1. Patients with positive pelvic lymph nodes and positive para-aortic lymph nodes by PET will be assigned to treatment arm 2.

Treatment Group 1. Either a conventional or CT simulation may be performed. Patients will be treated with IMRT extended field external beam radiation therapy (to cover pelvis and para-aortic lymph nodes) and intracavitary radiation (6 high dose radiation (HDR) treatments) concurrently with cisplatin (40 mg/m^2/week)

Treatment Group 2. A CT simulation must be performed. Patients will be treated with extended field external beam radiation therapy to the pelvis and with IMRT to cover the para-aortic lymph nodes to 60 Gy, 50.4 Gy to the para-aortic lymph node bed in conjunction with external beam pelvic radiation therapy as appropriate for disease stage and intracavitary radiation (6 HDR treatments) concurrently with cisplatin (40 mg/m^2/week).

Type d'étude

Interventionnel

Inscription (Réel)

69

Phase

  • Phase 2

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

  • États-Unis
    • Missouri
      • St. Louis, Missouri, États-Unis, 63110
        • Washington University School of Medicine

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

18 ans et plus (Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Femelle

La description

Inclusion Criteria:

  • Patients must have carcinoma of the uterine cervix.
  • Patients with squamous cell, adenocarcinoma, and adenosquamous carcinoma are eligible.
  • International Federation of Gynecology and Obstetrics (FIGO) Stage I to IVA
  • Patients must have no evidence of metastatic disease outside of the pelvis (except to the para-aortic nodes), by PET.
  • Patients must have a Karnofsky Performance Status of >= 60 and no medical contraindications to the administration of chemotherapy.
  • Age >= 18.
  • Adequate bone marrow function: white blood cells (WBC) >= 4000/mm3, platelets >= 100,000 mm3.
  • Adequate renal function: BUN <= 25 mg/dl, creatinine <= 1.2 mg/dl (urinary diversion is permitted to improve renal function).
  • Patients must have bilirubin <= 1.5 mg/dl.
  • Signed study-specific informed consent.

Exclusion Criteria:

  • No positive lymph nodes by FDG PET
  • Positive supraclavicular lymph nodes by FDG PET Scan or evidence of more distant disease.
  • FIGO Stage IVB+ Cervical Cancer
  • No prior (within 5 years) or simultaneous malignancies (other than cutaneous basal cell carcinoma).
  • Karnofsky Performance Status <60.
  • Patients with significant medical illness preventing the use of full dose chemotherapy are excluded.
  • Patients with the following histologies are excluded: small cell, carcinoid, glassy cell, clear cell and adenoid cystic.
  • Life expectancy < 6 months.
  • Patients with poorly controlled diabetes mellitus (fasting blood glucose level > 200 mg/dL) are not eligible.
  • No prior surgery for treatment of disease other than exploratory laparotomy or biopsy.
  • No previous systemic chemotherapy.
  • No pelvic radiation therapy is permitted other than transvaginal irradiation to control bleeding.
  • Pregnant women are ineligible and those of child-bearing potential should practice contraception.
  • Patients with abnormal liver function tests

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: Non randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Aucun (étiquette ouverte)

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Expérimental: Treatment Group 1

Pelvic Lymph Nodes Only Positive on FDG PET.

IMRT External Beam radiation to the para-aortic region (45 Gy)

Pelvis intracavitary brachytherapy (6 HDR treatments)

Weekly cisplatin 40 mg/m^2
Médicament: Cisplatine
Radiation: Curiethérapie
Radiation: IMRT extended field external beam radiation therapy
Expérimental: Treatment Group 2

Para-Aortic Lymph Nodes Positive on FDG PET

IMRT (50.4 Gy to para-aortic lymph node bed with a 10.8 Gy boost to nodes)

IMRT external beam pelvic radiation therapy as appropriate for stage

Intracavitary brachytherapy (6 HDR treatments)

Weekly cisplatin (40 mg/m^2)
Médicament: Cisplatine
Radiation: Curiethérapie
Radiation: IMRT extended field external beam radiation therapy

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Tolerance of IMRT Extended-field External Radiotherapy to Pelvis and Para-aortic Region, Combined With Intracavitary Irradiation, and Cisplatin Chemotherapy as Measured the Number of Participants With by Grade 4 or Higher Toxicity
Délai: 1 year post start of radiation therapy
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 will be utilized for all toxicity reporting.
1 year post start of radiation therapy
Number of Participants With Acute Toxicity of IMRT Extended-field External Radiotherapy to Pelvis and Para-aortic Region, Combined With Intracavitary Irradiation, and Cisplatin Chemotherapy (Grade 3 or Higher)
Délai: 30 days after completion of radiation therapy
30 days after completion of radiation therapy
Efficacy of IMRT Extended-field Radiation Combined With Intracavitary Irradiation, and Cisplatin Chemotherapy as Measured by PET Scan Disease Status
Délai: 1st PET scan after completion of treatment (approximately month 6)
1st PET scan after completion of treatment (approximately month 6)

Mesures de résultats secondaires

Mesure des résultats
Délai
Efficacy of IMRT to the Para-aortic Lymph Nodes, IMRT External Beam Radiotherapy to the Pelvis, Intracavitary Irradiation, and Cisplatin Chemotherapy as Measured by the Frequency of Distant Metastasis
Délai: 5 years after completion of radiation therapy
5 years after completion of radiation therapy

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

Washington University School of Medicine

Les enquêteurs

  • Chercheur principal: Perry Grigsby, MD, Washington University School of Medicine

Publications et liens utiles

La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.

Liens utiles

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude

1 mai 2003

Achèvement primaire (Réel)

1 janvier 2013

Achèvement de l'étude (Réel)

1 janvier 2013

Dates d'inscription aux études

Première soumission

31 décembre 2007

Première soumission répondant aux critères de contrôle qualité

31 décembre 2007

Première publication (Estimation)

11 janvier 2008

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Estimation)

29 août 2016

Dernière mise à jour soumise répondant aux critères de contrôle qualité

18 juillet 2016

Dernière vérification

1 juin 2016

Plus d'information

Termes liés à cette étude

Mots clés

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • 03-0300 / 201105362

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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