Prophylactic Cranial Irradiation (PCI) for Small Cell Carcinoma of the Urothelium

This study is currently recruiting participants. (see Contacts and Locations)
Verified June 2014 by M.D. Anderson Cancer Center
Sponsor:
Information provided by (Responsible Party):
M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier:
NCT00756639
First received: September 18, 2008
Last updated: June 3, 2014
Last verified: June 2014
  Purpose

The goal of this clinical research study is to learn if whole brain radiation can lower the chances of developing brain tumors in patients with small cell carcinoma of the urinary tract, including the bladder. The safety of whole brain radiation will also be studied.

Objectives:

Primary:

To evaluate the effect of prophylactic cranial irradiation (PCI) on brain metastasis free survival at 1 year in patients with locally advanced/metastatic (i.e. > or = cT3b, > or = pT3b, N+, or M+) small cell carcinoma of the urothelium after chemotherapy.

Secondary:

To evaluate the effect of prophylactic cranial irradiation (PCI) on median time to develop brain metastases in patients with locally advanced/metastatic small cell carcinoma of the urothelium after chemotherapy.

To evaluate the effect of PCI on overall survival of patients with locally advanced/metastatic small cell carcinoma of the urothelium after chemotherapy.

To evaluate the toxicity of PCI in patients with locally advanced/metastatic small cell carcinoma of the urothelium after chemotherapy.


Condition Intervention Phase
Bladder Cancer
Radiation: Prophylactic Cranial Irradiation (PCI)
Other: Brain X-ray
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Prophylactic Cranial Irradiation (PCI) for Patients With Small Cell Carcinoma of the Urothelium

Resource links provided by NLM:


Further study details as provided by M.D. Anderson Cancer Center:

Primary Outcome Measures:
  • Brain Metastasis Free Survival [ Time Frame: At 1 Year ] [ Designated as safety issue: Yes ]
    Primary outcome for this trial is the rate of development of brain metastasis by 12 months following start of treatment. A "success" defined as a patient not developing brain metastasis by 12 months following start of treatment. After radiation therapy, participant has an MRI or a CT scan of the brain every 6 months for 1 year.


Estimated Enrollment: 30
Study Start Date: June 2008
Estimated Primary Completion Date: June 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Radiation
Prophylactic cranial irradiation (PCI) treatments to be started within 4 months after the end of chemotherapy or surgery to a total dose of 30 Gy, given at 2 Gy per fraction, 5 days per week for 3 weeks. On the first day of each week of therapy, a brain X-ray will done to see if the radiation is being given to the best area.
Radiation: Prophylactic Cranial Irradiation (PCI)
Prophylactic cranial irradiation (PCI) treatments to be started within 4 months after the end of chemotherapy or surgery to a total dose of 30 Gy, given at 2 Gy per fraction, 5 days per week for 3 weeks.
Other Names:
  • Whole Brain Radiation
  • Prophylactic cranial irradiation
  • PCI
Other: Brain X-ray
On the first day of each week of therapy, a brain X-ray will done to see if the radiation is being given to the best area.
Other Name: X-ray

Detailed Description:

MRI/CT Scans:

Within six (6) weeks before having whole brain radiation, you will have a magnetic resonance imaging (MRI) or a computed tomography (CT) scan of your brain to check if brain tumors have developed.

Simulation Visit:

Before the radiation therapy begins, you will have a "simulation visit" to plan for the radiation therapy. During this session, you will be fitted to a plastic mask to hold your head still during radiation. The mask is made of a material called "thermoplastic" that becomes soft when it is placed in warm water. While this plastic is soft, it will be pulled over your face to make a mold. When the plastic cools down, it will harden again and the mask will be completed. After the mask is made, a CT scan of your head will be done for treatment planning.

Radiation Therapy:

You will begin radiation within 1 week after the simulation visit. You will have radiation visits Monday through Friday for 3 weeks (15 total therapy visits). Each therapy session will last about 15 minutes. It will take the study staff about 10 minutes to position you on the table and put the mask on. The radiation will be given over 2-3 minutes.

On the first day of each week of therapy, you will have a brain X-ray to see if the radiation is being given to the best area.

Follow-Up:

After the radiation therapy, you will have an MRI or a CT scan of the brain every 6 months for 1 year and then every year for 5 years to check the status of the disease.

You will also complete a written mental status exam with your doctor every 3-6 months for 2 years and then every year for 5 years. The exam will have a series of tests to check your memory and ability to follow instructions. The test will take about 15 minutes to complete.

Length of Study:

You may remain on study for as long as you are benefitting. You will be taken off study if your disease gets worse or if intolerable side effects occur.

This is an investigational study. The use of radiation to check for brain tumors before they have formed is investigational.

Up to 30 patients will take part in this study. All will be enrolled at MD Anderson.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patients with histologically proven small cell carcinoma of the bladder, or elsewhere along the urothelium, which is locally advanced or metastatic (i.e. > or = cT3b, > or = pT3b, N+, or M+) at the time of presentation or cystectomy who have been treated with chemotherapy.
  2. Patients must have had a response to chemotherapy, which the investigator feels is likely to resulting systemic control of the cancer. In most instances, this would reflect a major response (i.e. > or = 90% reduction of tumor), though a lower percentage may be acceptable if the investigator feels the residual reflects another component, such as transitional cell carcinoma (TCC). Dr Arlene Siefker-Radtke will serve as the final arbiter when questions regarding response arise.
  3. Since small cell tumors of the bladder are often associated with other variant histology including TCC and adenocarcinoma, the presence of variant histology will be allowed.
  4. Patients must be > or = 18 years of age.
  5. Patients may be on other trials (either here at M.D. Anderson Cancer Center or at an outside institution) as long as the other eligibility criteria are met.
  6. Patients must not have any evidence of progressive disease at the time of study entry.
  7. Patients must have an MRI or CT of the head showing no CNS metastases within 6 weeks of study entry.
  8. Patients must have adequate physiologic reserves as evidenced by: a) Zubrod Performance Status (PS) of < or = 2; b) Adequate bone marrow reserves as evidenced by ANC > 1000, and platelet count > 100,000. Supranormal values judged to be of benign or inconsequential etiology will be acceptable.
  9. Patients must be enrolled within 6 months of completing chemotherapy or after surgery of the primary site. Any acute/subacute > or = grade 3 toxicities from the chemotherapy must be resolved to < or = grade 2 at the time of study entry. It is suggested that patients undergo prophylactic cranial irradiation as a soon as they have recovered from chemotherapy or surgery, at a minimum of 2 weeks, and up to 6 months following chemotherapy or surgery.

Exclusion Criteria:

  1. Patients with CNS metastasis at presentation will not be eligible.
  2. History of TIA or stroke within 6 months of study entry.
  3. Prior cranial irradiation.
  4. Pregnant women will not be eligible; women of childbearing potential must have a negative pregnancy test before starting therapy.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00756639

Contacts
Contact: Seungtaek Choi, MD 713-563-8617
Contact: Donna M Reeves 713-563-2365

Locations
United States, Texas
UT MD Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Contact: Toni Williams         
Principal Investigator: Seungtaek Choi, MD         
Sponsors and Collaborators
M.D. Anderson Cancer Center
Investigators
Principal Investigator: Seungtaek Choi, MD U.T. M.D. Anderson
  More Information

Additional Information:
No publications provided

Responsible Party: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT00756639     History of Changes
Other Study ID Numbers: 2007-0933, NCI-2012-01675
Study First Received: September 18, 2008
Last Updated: June 3, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by M.D. Anderson Cancer Center:
prophylactic cranial irradiation
small cell carcinoma of the bladder
urothelial carcinoma
genitourinary bladder
urothelium
bladder
bladder cancer
PCI
brain metastasis
genitourinary
radiation
TCC
adenocarcinoma

Additional relevant MeSH terms:
Carcinoma
Carcinoma, Small Cell
Small Cell Lung Carcinoma
Urinary Bladder Neoplasms
Bronchial Neoplasms
Carcinoma, Bronchogenic
Lung Diseases
Lung Neoplasms
Neoplasms
Neoplasms by Histologic Type
Neoplasms by Site
Neoplasms, Glandular and Epithelial
Respiratory Tract Diseases
Respiratory Tract Neoplasms
Thoracic Neoplasms
Urinary Bladder Diseases
Urogenital Neoplasms
Urologic Diseases
Urologic Neoplasms

ClinicalTrials.gov processed this record on October 21, 2014