Trial of Proton Versus Carbon Ion Radiation Therapy in Patients With Chordoma of the Skull Base - Full Text View

Purpose

This study is a prospective randomised clinical phase III trial. The primary objective of this study is to evaluate, if the innovative therapy (carbon ion irradiation) in chordomas is superior to the standard proton treatment with respect to the local-progression free survival (LPFS).

Condition	Intervention	Phase
Chordoma Tumor Treatment	Radiation: Carbon ion Radiation: Protons	Phase 3


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Treatment
Official Title:	Randomised Trial of Proton vs. Carbon Ion Radiation Therapy in Patients With Chordoma of the Skull Base -Clinical Phase III Study-

Resource links provided by NLM:

Genetics Home Reference related topics: chordoma

Genetic and Rare Diseases Information Center resources: Chordoma

U.S. FDA Resources

Further study details as provided by Heidelberg University:

Primary Outcome Measures:

local-progression free survival (LPFS) [ Time Frame: 8-years ]
The primary objective of this study is to evaluate, if the innovative therapy (carbon ion irradiation) in chordomas is superior to the standard proton treatment with respect to the LPFS defined as time from the randomisation to observed local reccurrence or death from any cause in the absence of documented local disease progression. Lo-cal recurrence defined as MRT or CT - morphological tumor progress in the former irradiated region. A 10% increase in the LPFS is considered clinically relevant as-suming that the LPFS rate for the proton therapy is 70%.

Secondary Outcome Measures:

Survival [ Time Frame: 8-years ]
Assessment of overall survival, progression free and metastasis free survival.
Local control and patterns of recurrence [ Time Frame: 8 years ]
Local recurrences will be confirmed radiologically and histologically whenever possible. At least two medical doctors (radiation oncologist and/or radiologist) will be required to judge of the recurrence.
Toxicity [ Time Frame: 8 years ]
Acute and late toxicity will be analysed due to Common Terminology Criteria for Adverse Events: CTCAE V4.0 for acute reaction and RTOG/EORTC for late effects.


Estimated Enrollment:	319
Study Start Date:	July 2010
Estimated Study Completion Date:	August 2023
Estimated Primary Completion Date:	August 2015 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: A Arm A (carbon ion therapy): Total dose to the PTV2 - 45 Gy E in 3 Gy E /d, 4-6 days a week, 15 fractions Total dose to the PTV1 - 63 Gy E ± 5%, further 5-7 fractions a 3 Gy E.	Radiation: Carbon ion Arm A (carbon ion therapy): Total dose to the PTV2 - 45 Gy E in 3 Gy E /d, 4-6 days a week, 15 fractions Total dose to the PTV1 - 63 Gy E ± 5%, further 5-7 fractions a 3 Gy E.
Active Comparator: B Arm B (proton therapy): Total dose to the PTV2 - 50 to 56 Gy E in 2 Gy E /d, 4-6 days a week, 28 fractions Total dose to the PTV1 - 72 Gy E ± 5%, further 6-9 fractions a 2 Gy E.	Radiation: Protons Arm B (proton therapy): Total dose to the PTV2 - 50 to 56 Gy E in 2 Gy E /d, 4-6 days a week, 28 fractions Total dose to the PTV1 - 72 Gy E ± 5%, further 6-9 fractions a 2 Gy E.

Detailed Description:

The study is a prospective randomised clinical phase III trial. The trial will be carried out at Heidelberger Ionenstrahl-Therapie (HIT) centre as monocentric trial.

Proton therapy is the gold standard in the treatment of skull base chordomas. However, high-LET beams such as carbon ions theoretically offer biologic advantages by enhanced biologic effectiveness in slow-growing tumors. Up until now it was impossible to compare two different particle therapies, i.e. proton and carbon ion therapy directly with each other. The aim of this study is to find out, whether the biological advantages of carbon ion therapy mentioned above can also be clinically confirmed.

Patients with skull base chordoma will be randomised to either proton or carbon ion radiation therapy. As a standard, patients will undergo non-invasive, rigid immobilization and target volume delineation will be carried out based on CT and MRI data. The biologically isoeffective target dose to the PTV in carbon ion treatment (accelerated dose) will be 63 Gy E ± 5% and 72 Gy E ± 5% (standard dose) in proton therapy respectively. Local-progression free survival (LPFS) will be analysed as primary end point. Toxicity and survival are the secondary end points. Also matters of interest are patterns of recurrence, prognostic factors and plan quality.

Eligibility


Ages Eligible for Study:	18 Years to 80 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Karnofsky Performance Score ≥60%
Age >18 years and <80 years
Informed consent signed by the patient
Histological confirmation of chordoma with infiltration of the skull base.

Exclusion Criteria:

Inability to understand the aims of the study, no informed consent
Prior RT of skull base region
Other malignancies with disease-free interval < 5 years (excepting pre- cancerous lesions)
Participation in another trial
Pregnancy
Simultaneous CHT or Immunotherapy.

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: NCT01182779

Contacts


Contact: Anna V. Nikoghosyan, MD	+496221568202	anna.nikoghosyan@med.uni-heidelberg.de
Contact: Juergen Debus, MD, PhD	+496221568202	juergen.debus@med.uni-heidelberg.de

Locations


Germany
University of Heidelberg	Recruiting
Heidelberg, Germany, 69120
Principal Investigator: Juergen Debus, MD, PhD
Sub-Investigator: Anna V. Nikoghosyan, MD

Sponsors and Collaborators

Heidelberg University

Investigators


Principal Investigator:	Juergen Debus, MD PhD	Heidelberg University

More Information

Publications:

Munzenrider JE, Liebsch NJ. Proton therapy for tumors of the skull base. Strahlenther Onkol. 1999 Jun;175 Suppl 2:57-63. Review.

Ares C, Hug EB, Lomax AJ, Bolsi A, Timmermann B, Rutz HP, Schuller JC, Pedroni E, Goitein G. Effectiveness and safety of spot scanning proton radiation therapy for chordomas and chondrosarcomas of the skull base: first long-term report. Int J Radiat Oncol Biol Phys. 2009 Nov 15;75(4):1111-8. doi: 10.1016/j.ijrobp.2008.12.055. Epub 2009 Apr 20.

Hug EB. Review of skull base chordomas: prognostic factors and long-term results of proton-beam radiotherapy. Neurosurg Focus. 2001 Mar 15;10(3):E11. Review.

Hug EB, Slater JD. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. Neurosurg Clin N Am. 2000 Oct;11(4):627-38. Review.

Weber DC, Rutz HP, Pedroni ES, Bolsi A, Timmermann B, Verwey J, Lomax AJ, Goitein G. Results of spot-scanning proton radiation therapy for chordoma and chondrosarcoma of the skull base: the Paul Scherrer Institut experience. Int J Radiat Oncol Biol Phys. 2005 Oct 1;63(2):401-9.

Schulz-Ertner D, Karger CP, Feuerhake A, Nikoghosyan A, Combs SE, Jäkel O, Edler L, Scholz M, Debus J. Effectiveness of carbon ion radiotherapy in the treatment of skull-base chordomas. Int J Radiat Oncol Biol Phys. 2007 Jun 1;68(2):449-57. Epub 2007 Mar 23.

Mizoe JE, Hasegawa A, Takagi R, Bessho H, Onda T, Tsujii H. Carbon ion radiotherapy for skull base chordoma. Skull Base. 2009 May;19(3):219-24. doi: 10.1055/s-0028-1114295.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Nikoghosyan AV, Karapanagiotou-Schenkel I, Münter MW, Jensen AD, Combs SE, Debus J. Randomised trial of proton vs. carbon ion radiation therapy in patients with chordoma of the skull base, clinical phase III study HIT-1-Study. BMC Cancer. 2010 Nov 5;10:607. doi: 10.1186/1471-2407-10-607.


Responsible Party:	Juergen Debus, MD PhD, Dept. of Radiation Oncology, INF 400, 69120 Heidelberg, University of Heidelberg
ClinicalTrials.gov Identifier:	NCT01182779 History of Changes
Other Study ID Numbers:	HIT-1
Study First Received:	July 26, 2010
Last Updated:	August 16, 2010

Keywords provided by Heidelberg University:


base of skull chordoma radiation carbon ions protons

Additional relevant MeSH terms:


Chordoma Neoplasms, Germ Cell and Embryonal Neoplasms by Histologic Type Neoplasms

ClinicalTrials.gov processed this record on August 17, 2017

Trial of Proton Versus Carbon Ion Radiation Therapy in Patients With Chordoma of the Skull Base (HIT-1)