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Breast-Sparing Proton Therapy for Hodgkin's Disease (Breast Sparing)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02070393
Recruitment Status : Terminated (Closure of Indiana University Health Proton Center in December 2014)
First Posted : February 25, 2014
Last Update Posted : February 4, 2015
Information provided by (Responsible Party):
Indiana University

Brief Summary:
The purpose of this study is to drastically reduce unnecessary breast dose in young females with Hodgkin's Disease who require radiation therapy.

Condition or disease Intervention/treatment Phase
Hodgkins Disease Radiation: Proton Early Phase 1

Detailed Description:

According to the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, there will be an estimated 8,490 new cases of Hodgkin's Lymphoma (HL) in the United States in 2010, with an estimated 1,320 deaths (Jemal, Siegel et al.). The unadjusted rates of 5 year overall survival are approximately 95%, and remain among the highest of all childhood and adult malignancies. With many children and young adults surviving into advanced age, the impetus has been to develop less toxic yet equally effective treatments. One of the main approaches taken over the last 25 years to minimize long-term treatment toxicity has been to limit the amount and volume of radiation received by patients. This pilot study continues along those lines, attempting to further refine the delivery of radiation therapy (RT) in order to avoid one of the most notorious long-term side-effects: secondary breast cancer.

Multiple studies investigating late toxicity in long-term survivors of pediatric Hodgkin's Lymphoma have shown the risk of breast cancer in young females receiving mediastinal radiation to be 50 times greater than their age-matched counterparts. The Late Effects Study Group, with a median follow-up of 17 years, reported a breast cancer incidence of 16% with a standardized incidence ratio of 55.5 (Bhatia, Yasui et al. 2003). Through utilization of breast-sparing proton therapy, we hope to provide young female patients with the benefits of radiation therapy while decreasing their risk of secondary breast cancer, thus increasing the therapeutic ratio.

In a prior computer-based, in-silico, dose planning study, utilizing the most basic beam orientation (a single PA beam), we showed that dose to breast tissue was reduced by a minimum of at least 80% with proton treatment compared to standard AP-PA photon treatment (in publication). Furthermore, dose to clinical target volume was maintained, and dose to other normal structures was statistically no worse. We now aim to validate these findings by verifying the beam range, in-vivo, via post-treatment combined Positron Emission Tomography-Computer Tomography (PET-CT) imaging in young females undergoing supra-diaphragmatic radiotherapy for Hodgkin's Disease.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 3 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: Single (Investigator)
Primary Purpose: Treatment
Official Title: Breast-Sparing Proton Therapy for Hodgkin's Disease in Young Females Demonstrated By Positron Emission Tomograpy (PET) Scanning: A Pilot Study
Study Start Date : September 2011
Actual Primary Completion Date : February 2015
Actual Study Completion Date : February 2015

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Hodgkin Disease

Arm Intervention/treatment
Experimental: Radiation Treatment using Protons
14 -24 Radiation Treatments (typically 1.5 - 1.8 cobalt-Gray equivalent per fraction for 14-24 treatments).
Radiation: Proton
14-24 Radiation treatments using Protons
Other Name: Breast sparing using proton beams

Primary Outcome Measures :
  1. Comparative DVH data for delivered proton plan and accompanying photon plan for target volume and normal tissues. [ Time Frame: 12 months ]

    Dose-volume histogram data from both the delivered proton plan and the accompanying photon plan for target volumes and normal tissues, including:

    • Breast, heart, lung, thyroid, parotid glands , esophagus, spinal cord, *liver, *kidneys,

Secondary Outcome Measures :
  1. Treatment toxicity and disease control of proton therapy for the treatment of pediatric Hodgkin's Lymphoma. [ Time Frame: 3 - 60 Months ]
    1. Acute toxicity as per CTCAE v4.0
    2. Local, regional, and distal control of the disease at 3 years

Information from the National Library of Medicine

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, Learn About Clinical Studies.

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Ages Eligible for Study:   10 Years to 30 Years   (Child, Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Female sex
  • Age >/= 10 years old and < 30 years old
  • Pathologically confirmed classical Hodgkin's Lymphoma
  • At least one site of disease located above the diaphragm
  • Signed study-specific consent prior to initiation of therapy
  • Women of child-bearing potential must have a negative pregnancy blood test within 7 days of starting protocol therapy.

Exclusion Criteria:

  • Previous radiation therapy to any part of the body.
  • Parenchymal lung involvement at initial presentation or any patient that may need whole lung irradiation as per institutional guidelines.
  • Lymphocyte predominant histology not eligible.
  • Significant infection or other coexistent medical condition that would preclude protocol therapy such as:

    • History of HIV/AIDS
    • History of collagen Vascular Disease
    • Symptomatic congestive heart failure
    • Unstable angina pectoris or myocardial infarction within 6 months
    • Uncontrolled hypertension (systolic blood pressure > 160 mm Hg or diastolic blood pressure > 100 mm Hg on 2 consecutive measurements separated by 1 week).
    • History of uncontrolled diabetes
    • Psychiatric illness/social situations that would compromise patient safety or limit compliance with study requirements

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02070393

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United States, Indiana
Indiana University Health Proton Therapy Center
Bloomington, Indiana, United States, 47408
Sponsors and Collaborators
Indiana University
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Principal Investigator: Jeffery Buchsbuam, MD Indiana University
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Responsible Party: Indiana University Identifier: NCT02070393    
Other Study ID Numbers: IUHPTC-01
First Posted: February 25, 2014    Key Record Dates
Last Update Posted: February 4, 2015
Last Verified: February 2015
Keywords provided by Indiana University:
Hodgkins Disease in Young Females
Breast Sparing Radiation Treatments
Additional relevant MeSH terms:
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Hodgkin Disease
Neoplasms by Histologic Type
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases