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Radioterapia protonami lub fotonami w leczeniu pacjentów z rakiem wątroby

9 października 2026 zaktualizowane przez: NRG Oncology

Randomizowana próba fazy III protonów w porównaniu z fotonami w raku wątrobowokomórkowym

This phase III trial studies how well radiation therapy with protons works compared with photons in treating patients with liver cancer. Radiation therapy, such as photon therapy, uses high energy x-rays to send the radiation inside the body to the tumor while proton therapy uses a beam of proton particles. Proton therapy can stop shortly after penetrating through the tumor and may cause less damage to the surrounding healthy organs and result in better survival in patients with liver cancer.

Przegląd badań

Status

Aktywny, nie rekrutujący

Warunki

Interwencja / Leczenie

Szczegółowy opis

PRIMARY OBJECTIVE:

I. To determine if overall survival (OS) is different for hepatocellular carcinoma patients treated with protons compared to photons.

SECONDARY OBJECTIVES:

I. To determine the difference in progression-free-survival (PFS) in patients with hepatocellular carcinoma (HCC) treated with protons compared to patients with HCC treated with photons.

II. To determine the difference in local progression (LP) in patients with HCC treated with protons compared to patients with HCC treated with photons.

III. To determine differences in toxicity in patients with HCC treated with protons versus photons.

IV. To determine differences in fatigue, as measured by Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue in patients with HCC treated with protons, versus photons; as well as quality-adjusted survival, if the primary endpoint is met.

V. To determine if there are correlations between the baseline values of hepatocyte growth factor (HGF) and outcomes (OS/PFS/fatigue).

EXPLORATORY OBJECTIVES:

I. To determine differences in overall quality of life, measured by Functional Assessment of Cancer Therapy-Hepatobiliary Cancer (FACT-Hep) in patients with HCC treated with protons.

II. Biospecimen collection for future correlative science projects.

OUTLINE: Patients are randomized to 1 of 2 arms, photon or proton therapy (see Arms and Interventions).

Patients undergo computed tomography (CT) scan, magnetic resonance imaging (MRI) and blood sample collection throughout the study.

After completion of study treatment, patients are followed up every 3 months for 2 years, every 6 months for 3 years, and then yearly thereafter.

Typ studiów

Interwencyjne

Zapisy (Rzeczywisty)

116

Faza

  • Faza 3

Kontakty i lokalizacje

Ta sekcja zawiera dane kontaktowe osób prowadzących badanie oraz informacje o tym, gdzie badanie jest przeprowadzane.

Lokalizacje studiów

    • Georgia
      • Atlanta, Georgia, Stany Zjednoczone, 30308
        • Emory University Hospital Midtown
      • Atlanta, Georgia, Stany Zjednoczone, 30322
        • Emory University Hospital/Winship Cancer Institute
      • Atlanta, Georgia, Stany Zjednoczone, 30342
        • Emory Saint Joseph's Hospital
      • Atlanta, Georgia, Stany Zjednoczone, 30308
        • Emory Proton Therapy Center
    • Illinois
      • Warrenville, Illinois, Stany Zjednoczone, 60555
        • Northwestern Medicine Cancer Center Warrenville
    • Maryland
      • Baltimore, Maryland, Stany Zjednoczone, 21201
        • University of Maryland/Greenebaum Cancer Center
      • Baltimore, Maryland, Stany Zjednoczone, 21201
        • Maryland Proton Treatment Center
    • Massachusetts
      • Boston, Massachusetts, Stany Zjednoczone, 02114
        • Massachusetts General Hospital Cancer Center
    • Michigan
      • Dearborn, Michigan, Stany Zjednoczone, 48124
        • Corewell Health Dearborn Hospital
      • Royal Oak, Michigan, Stany Zjednoczone, 48073
        • Corewell Health William Beaumont University Hospital
      • Troy, Michigan, Stany Zjednoczone, 48085
        • Corewell Health Beaumont Troy Hospital
    • Missouri
      • St Louis, Missouri, Stany Zjednoczone, 63110
        • Washington University School of Medicine
    • New Jersey
      • Basking Ridge, New Jersey, Stany Zjednoczone, 07920
        • Memorial Sloan Kettering Basking Ridge
      • Middletown, New Jersey, Stany Zjednoczone, 07748
        • Memorial Sloan Kettering Monmouth
      • Montvale, New Jersey, Stany Zjednoczone, 07645
        • Memorial Sloan Kettering Bergen
    • New York
      • Commack, New York, Stany Zjednoczone, 11725
        • Memorial Sloan Kettering Commack
      • East White Plains, New York, Stany Zjednoczone, 10604
        • Memorial Sloan Kettering Westchester
      • New York, New York, Stany Zjednoczone, 10065
        • Memorial Sloan Kettering Cancer Center
      • New York, New York, Stany Zjednoczone, 10035
        • New York Proton Center
      • Uniondale, New York, Stany Zjednoczone, 11553
        • Memorial Sloan Kettering Nassau
    • Ohio
      • Cincinnati, Ohio, Stany Zjednoczone, 45219
        • University of Cincinnati Cancer Center-UC Medical Center
      • Cleveland, Ohio, Stany Zjednoczone, 44106
        • Case Western Reserve University
      • Columbus, Ohio, Stany Zjednoczone, 43210
        • Ohio State University Comprehensive Cancer Center
      • West Chester, Ohio, Stany Zjednoczone, 45069
        • University of Cincinnati Cancer Center-West Chester
    • Texas
      • Houston, Texas, Stany Zjednoczone, 77030
        • UT MD Anderson Cancer Center
    • Washington
      • Seattle, Washington, Stany Zjednoczone, 98195
        • University of Washington Medical Center - Montlake
      • Seattle, Washington, Stany Zjednoczone, 98109
        • Fred Hutchinson Cancer Center

Kryteria uczestnictwa

Badacze szukają osób, które pasują do określonego opisu, zwanego kryteriami kwalifikacyjnymi. Niektóre przykłady tych kryteriów to ogólny stan zdrowia danej osoby lub wcześniejsze leczenie.

Kryteria kwalifikacji

Wiek uprawniający do nauki

18 lat i starsze (Dorosły, Starszy dorosły)

Akceptuje zdrowych ochotników

Nie

Płeć kwalifikująca się do nauki

Wszystko

Opis

Inclusion Criteria:

  • Pathologically (histologically or cytologically) or radiographically-proven (based on the American Association for the Study of Liver Diseases [AALSD] criteria) unresectable or locally recurrent hepatocellular cancer prior to registration

  • Appropriate stage for study entry based on the following diagnostic workup:

    • All patients must have computed tomography (CT) scan chest/abdomen/pelvis with multiphasic liver CT scan prior to registration; if CT contrast is contraindicated, CT chest without contrast and magnetic resonance imaging (MRI) of abdomen is permitted
    • Participants must have measurable disease at study entry, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as > 2 cm with conventional techniques or as > 1 cm with spiral CT scan
    • Patient must have 3 or fewer single or multinodular tumors; for patients with a single lesion, lesion must be 15 cm or less in greatest dimension; for patients with two lesions, no lesion may be greater than 10 cm in greatest dimension; for patients with three lesions, no lesion may be greater than 6 cm in greatest dimension; portal vein involvement or thrombosis combined with a single lesion that is >= 1 cm and =< 15 cm in greatest dimension is allowed
  • Age >= 18

  • Zubrod performance status 0-1 within 30 days prior to registration

  • Negative urine or serum pregnancy test for women of childbearing potential within 7 days prior to study entry

  • Absolute neutrophil count (ANC) >= 1,000 cells/mm^3

  • Platelets >= 50,000 cells/mm^3

  • Hemoglobin >= 9.0 g/dl; (Note: The use of transfusion or other intervention to achieve hemoglobin [Hgb] >= 9.0 g/dl is acceptable)

  • Total bilirubin < 4 x institutional upper limit of normal (ULN)

  • Transaminases (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) < 6 x institutional ULN

  • Albumin >= 2.5 g/dl

  • Creatinine < 2 mg/dl

  • Prior chemotherapy, targeted biological therapy (e.g. sorafenib), surgery, transarterial chemoembolization (TACE), ablation for present disease is acceptable

  • Must have Child-Turcotte-Pugh (CTP) A or B7

  • The patient or a legally authorized representative must provide study-specific informed consent prior to study registration

Exclusion Criteria:

  • PRIOR TO STEP ONE REGISTRATION:
  • Definitive clinical or radiologic documentation of extrahepatic tumor, defined as extrahepatic metastases or malignant nodes (that enhance with typical features of HCC) > 3.0 cm, in sum of maximal diameters (e.g. presence of one 3.4 cm metastatic lymph node or two 2 cm lung lesions); note that benign non-enhancing periportal lymphadenopathy is not unusual in the presence of hepatitis and is permitted, even if the sum of enlarged nodes is > 2.0 cm
  • Uncontrolled prior invasive malignancy, excluding the current diagnosis
  • Systemic chemotherapy for the study cancer < 2 weeks prior to registration
  • Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception; this exclusion is necessary because the treatment involved in this study may be significantly teratogenic
  • HIV positive with CD4 count < 200 cells/microliter; note that patients who are human immunodeficiency virus (HIV) positive are eligible, provided they are under treatment with highly active antiretroviral therapy (HAART) and have a CD4 (cluster of differentiation 4)count >= 200 cells/microliter prior to registration; note also that HIV testing is not required for eligibility for this protocol; this exclusion criterion is necessary because the treatments involved in this protocol may be significantly immunosuppressive
  • Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields (to include Y90)
  • Prior liver transplant
  • PRIOR TO STEP TWO RANDOMIZATION:
  • Unable to obtain confirmation of payment coverage (insurance or other) for either possible treatment

Plan studiów

Ta sekcja zawiera szczegółowe informacje na temat planu badania, w tym sposób zaprojektowania badania i jego pomiary.

Jak projektuje się badanie?

Szczegóły projektu

  • Główny cel: Leczenie
  • Przydział: Randomizowane
  • Model interwencyjny: Przydział równoległy
  • Maskowanie: Brak (otwarta etykieta)

Broń i interwencje

Grupa uczestników / Arm
Interwencja / Leczenie
Eksperymentalny: Proton Therapy (Arm 1)

Proton therapy delivered in 5 fractions over 15 days or 15 fractions over 24 days, determined by the treating physician.

Fractions

Inne nazwy:
  • Radioterapia raka
  • RODZAJ_ENERGII
  • Naświetlać
  • Napromieniowany
  • Naświetlanie
  • Promieniowanie
  • Radioterapia, NOS
  • Radioterapia
  • RT
  • Terapia, promieniowanie
  • Rodzaj energii
Eksperymentalny: Photon Therapy (Arm 2)

Photon therapy delivered in 5 fractions over 15 days or 15 fractions over 24 days, determined by the treating physician.

Fractions

Inne nazwy:
  • Radioterapia raka
  • RODZAJ_ENERGII
  • Naświetlać
  • Napromieniowany
  • Naświetlanie
  • Promieniowanie
  • Radioterapia, NOS
  • Radioterapia
  • RT
  • Terapia, promieniowanie
  • Rodzaj energii

Co mierzy badanie?

Podstawowe miary wyniku

Miara wyniku
Opis środka
Ramy czasowe
Percentage of Participants Alive (Overall Survival)
Ramy czasowe: From randomization to death or last follow-up. Median follow-up time for all patients at time of analysis was 20.4 months. One- and two-year estimates are reported.

Survival rates are estimated using the Kaplan-Meier method, censoring participants alive at last known follow-up.

From randomization to death or last follow-up. Median follow-up time for all patients at time of analysis was 20.4 months. One- and two-year estimates are reported.

Miary wyników drugorzędnych

Miara wyniku
Opis środka
Ramy czasowe
Percentage of Participants Alive Without Progression (Progression-free Survival)
Ramy czasowe: From randomization to progression, death, or last follow-up, whichever occurs first. Median follow-up time for all patients at time of analysis was 20.4 months. One- and two-year estimates are reported.

Progression is defined as local, regional, or distant progression. Progression-free survival rates are estimated using the Kaplan-Meier method, censoring participants alive without progression at time of last follow-up.

From randomization to progression, death, or last follow-up, whichever occurs first. Median follow-up time for all patients at time of analysis was 20.4 months. One- and two-year estimates are reported.
Percentage of Participants With Local Progression
Ramy czasowe: From randomization to local progression, death, or last follow-up, whichever occurs first. Median follow-up time for all patients at time of analysis was 20.4 months. One- and two-year estimates are reported.

Local progression rates are estimated using the cumulative incidence method in which death is treated as competing risk and participants alive without local failure are censored at last known follow-up.

From randomization to local progression, death, or last follow-up, whichever occurs first. Median follow-up time for all patients at time of analysis was 20.4 months. One- and two-year estimates are reported.
Percentage of Participants With Grade 3+ Treatment-Related Adverse Events
Ramy czasowe: From randomization to death or last follow-up. Median follow-up time for all patients at time of analysis was 20.4 months.

Common Terminology Criteria for Adverse Events (version 5.0) grades adverse event severity as follows: 1 = mild, 2 = moderate, 3 = severe, 4 = life-threatening, 5 = death related to adverse event. Adverse events reported as possibly, probably, or definitely related to treatment are considered to be treatment-related adverse events.

From randomization to death or last follow-up. Median follow-up time for all patients at time of analysis was 20.4 months.
Change From Baseline to One Month in the Patient Reported Outcomes Measurement Information System - Fatigue Short Form version1.0 8a [PROMIS Fatigue Score]
Ramy czasowe: Baseline and one month

The PROMIS Fatigue Short Form v1.0 8a contains 8 items that assess self-reported fatigue symptoms over the past 7 days. Item responses are summed to obtain a raw score ranging from 8 to 40, which is then converted to a standardized T-score (mean = 50, standard deviation = 10). Higher T-scores indicate greater fatigue. Change from baseline is calculated as the post-baseline T-score minus the baseline T-score, with positive change scores indicating increased fatigue and negative change scores indicating decreased fatigue.

Baseline and one month
Quality-adjusted LIfe Years
Ramy czasowe: Baseline up to 12 months

Was to be calculated using the EuroQol 5-Dimension Three Level Questionnaire (EQ-5D-3L).

Baseline up to 12 months
Percentage of Participants Alive (Overall Survival) by Plasma Hepatocyte Growth Factor (HGF) Level
Ramy czasowe: From randomization to death or last follow-up. One- and two-year estimates will be reported.

Survival rates are estimated using the Kaplan-Meier method, censoring participants alive at last known follow-up. HGF will be dichotomized at 2311 pg/mL.

From randomization to death or last follow-up. One- and two-year estimates will be reported.
Percentage of Participants Alive Without Progression (Progression-free Survival) by HGF Level
Ramy czasowe: From randomization to progression, death, or last follow-up, whichever occurs first. One- and two-year estimates will be reported.

Progression is defined as local, regional, or distant progression. Progression-free survival rates are estimated using the Kaplan-Meier method, censoring participants alive without progression at time of last follow-up. HGF will be dichotomized at 2311 pg/mL.

From randomization to progression, death, or last follow-up, whichever occurs first. One- and two-year estimates will be reported.
Change From Baseline to One Month in PROMIS Fatigue Score by HGF Level
Ramy czasowe: Baseline and one month

The PROMIS Fatigue Short Form v1.0 8a contains 8 items that assess self-reported fatigue symptoms over the past 7 days. Item responses are summed to obtain a raw score ranging from 8 to 40, which is then converted to a standardized T-score (mean = 50, standard deviation = 10). Higher T-scores indicate greater fatigue. Change from baseline is calculated as the post-baseline T-score minus the baseline T-score, with positive change scores indicating increased fatigue and negative change scores indicating decreased fatigue. HGF will be dichotomized at 2311 pg/mL.

Baseline and one month

Inne miary wyników

Miara wyniku
Opis środka
Ramy czasowe
Overall Quality of Life by Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) Version 4
Ramy czasowe: Baseline up to 12 months

Differences between treatment arms in the overall score, the four domains (physical, social, emotional, and functional well-being), and the additional concerns subscale will also be analyzed.

Baseline up to 12 months
Title: Percentage of Participants Alive (Overall Survival) by Sex
Ramy czasowe: From randomization to death or last follow-up. Median follow-up for all patients at time of analysis was 20.4 months. Two-year estimates are reported.

NIH-required analysis. Survival rates are estimated using the Kaplan-Meier method, censoring participants alive at time of analysis.

From randomization to death or last follow-up. Median follow-up for all patients at time of analysis was 20.4 months. Two-year estimates are reported.
Percentage of Participants Alive (Overall Survival) by Race
Ramy czasowe: From randomization to death or last follow-up. Median follow-up time for all patients at time of analysis was 20.4 months. Two-year estimates are reported.

NIH-required analysis. Survival rates are estimated using the Kaplan-Meier method, censoring participants alive at time of analysis.

From randomization to death or last follow-up. Median follow-up time for all patients at time of analysis was 20.4 months. Two-year estimates are reported.
Percentage of Participants Alive (Overall Survival) by Ethnicity
Ramy czasowe: From randomization to death or last follow-up. Median follow-up time for all patients at time of analysis was 20.4 months. Two-year estimates are reported.

NIH-required analysis. Survival rates are estimated using the Kaplan-Meier method, censoring participants alive at time of analysis.

From randomization to death or last follow-up. Median follow-up time for all patients at time of analysis was 20.4 months. Two-year estimates are reported.

Współpracownicy i badacze

Tutaj znajdziesz osoby i organizacje zaangażowane w to badanie.

Sponsor

Współpracownicy

Śledczy

  • Główny śledczy: Theodore S Hong, NRG Oncology

Publikacje i pomocne linki

Osoba odpowiedzialna za wprowadzenie informacji o badaniu dobrowolnie udostępnia te publikacje. Mogą one dotyczyć wszystkiego, co jest związane z badaniem.

Daty zapisu na studia

Daty te śledzą postęp w przesyłaniu rekordów badań i podsumowań wyników do ClinicalTrials.gov. Zapisy badań i zgłoszone wyniki są przeglądane przez National Library of Medicine (NLM), aby upewnić się, że spełniają określone standardy kontroli jakości, zanim zostaną opublikowane na publicznej stronie internetowej.

Główne daty studiów

Rozpoczęcie studiów (Rzeczywisty)

26 stycznia 2018

Zakończenie podstawowe (Rzeczywisty)

20 stycznia 2026

Ukończenie studiów (Szacowany)

20 stycznia 2031

Daty rejestracji na studia

Pierwszy przesłany

12 czerwca 2017

Pierwszy przesłany, który spełnia kryteria kontroli jakości

12 czerwca 2017

Pierwszy wysłany (Rzeczywisty)

14 czerwca 2017

Aktualizacje rekordów badań

Ostatnia wysłana aktualizacja (Rzeczywisty)

3 listopada 2026

Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości

9 października 2026

Ostatnia weryfikacja

1 października 2026

Więcej informacji

Terminy związane z tym badaniem

Inne numery identyfikacyjne badania

  • NRG-GI003
  • U10CA180868 (Grant/umowa NIH USA)
  • NRG-GI003 (Inny identyfikator: CTEP)
  • NCI-2016-02009 (Identyfikator rejestru: CTRP (Clinical Trial Reporting Program))
  • NRG-GI003 (Inny identyfikator: NRG Oncology)

Plan dla danych uczestnika indywidualnego (IPD)

Planujesz udostępniać dane poszczególnych uczestników (IPD)?

TAK

Opis planu IPD

NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page.

Informacje o lekach i urządzeniach, dokumenty badawcze

Bada produkt leczniczy regulowany przez amerykańską FDA

Nie

Bada produkt urządzenia regulowany przez amerykańską FDA

Nie

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