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

18 juli 2016 bijgewerkt door: 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.

Studie Overzicht

Toestand

Beëindigd

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

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).

Studietype

Ingrijpend

Inschrijving (Werkelijk)

69

Fase

  • Fase 2

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • Verenigde Staten
    • Missouri
      • St. Louis, Missouri, Verenigde Staten, 63110
        • Washington University School of Medicine

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar en ouder (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Vrouw

Beschrijving

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

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Niet-gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: 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
Geneesmiddel: Cisplatine
Straling: Brachytherapie
Straling: IMRT extended field external beam radiation therapy
Experimenteel: 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)
Geneesmiddel: Cisplatine
Straling: Brachytherapie
Straling: IMRT extended field external beam radiation therapy

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
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
Tijdsspanne: 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)
Tijdsspanne: 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
Tijdsspanne: 1st PET scan after completion of treatment (approximately month 6)
1st PET scan after completion of treatment (approximately month 6)

Secundaire uitkomstmaten

Uitkomstmaat
Tijdsspanne
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
Tijdsspanne: 5 years after completion of radiation therapy
5 years after completion of radiation therapy

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Washington University School of Medicine

Onderzoekers

  • Hoofdonderzoeker: Perry Grigsby, MD, Washington University School of Medicine

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Nuttige links

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 mei 2003

Primaire voltooiing (Werkelijk)

1 januari 2013

Studie voltooiing (Werkelijk)

1 januari 2013

Studieregistratiedata

Eerst ingediend

31 december 2007

Eerst ingediend dat voldeed aan de QC-criteria

31 december 2007

Eerst geplaatst (Schatting)

11 januari 2008

Updates van studierecords

Laatste update geplaatst (Schatting)

29 augustus 2016

Laatste update ingediend die voldeed aan QC-criteria

18 juli 2016

Laatst geverifieerd

1 juni 2016

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • 03-0300 / 201105362

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