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A Phase I Evaluating Integration of HypofractionatedStudy Renal Ablative Radiotherapy

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: NCT02264548
Recruitment Status : Active, not recruiting
First Posted : October 15, 2014
Last Update Posted : August 15, 2019
Information provided by (Responsible Party):
Belal Ahmad, Lawson Health Research Institute

Brief Summary:
  • evaluate the safety and toxicity profile of renal radio-ablation in the setting of metastatic renal cell carcinoma.
  • to assess renal function post radio-ablation
  • Primary and metastatic tumour response to radio-ablation

Condition or disease Intervention/treatment Phase
Renal Cell Carcinoma Radiation: Radio-Ablation Phase 1

Detailed Description:

A dose limiting toxicity (DLT) will be defined as any grade 3, 4 or 5 toxicity event that is considered to be definitely, probably or possibility related to the protocol radiation therapy. Patients that cannot complete protocol therapy due to acute radiation side-effects will also be considered to be a DLT. The general (non-exhausive) list of organ based toxicity that could be related to this type of radiation therapy include toxicity to the liver, kidney, bowel, spinal cord, and pancreas. Side-effects that are exclusively due to TKI targeted therapy are not considered to be DLT in this protocol.

Three patients will be recruited for the first cohort of the trial. These patients will have the PTV prescribed a dose of 25 Gray to be given in 5 daily fractions over a period of one week (first treatment to start on a Wednesday or Thursday, with planned treatment on successive business days). All therapy should be delivered within 10 business days including any treatment breaks for acute toxicity. After 3 patients have been seen at the 4 week follow up visit, CTCAE version three will be noted. If precisely 1 patient has a DLT, then an additional 3 patients will be recruited to the same cohort and given the same treatment. If no patient has DLT, then a new cohort of 3 patients will be treated to an increased dose of 30 Gray in 5 fractions. Similar criteria will dictate whether the trial ends, or continues with the next cohort being treated to a dose of 35 Gray in 5 daily fractions. There will be a maximum of 4 cohorts (25Gy, 30Gy, 35Gy, and 40Gy) in this study assuming no early DLT issues, each containing 3 or 6 patients. Allowance for a -1 cohort arm of 20 Gy in 5 fractions is made in this protocol for early DLT issues. The diagram below displays the schema in more detail.

Any patient that does not complete protocol therapy due to toxicity issues or is unavailable for the 4-week toxicity assessment is considered to be non-evaluable. These patients will need to be replaced in terms of study accrual. Patients are not to be given TKI therapy during the 4 week window post-RT in order to allow for proper evaluation of the RT intervention; however, the treating oncologist ultimately can override this if it is in the best medical interest of the patient (e.g. progressive and symptomatic systemic disease)

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I Study Evaluating the Integration of Hypofractionated Renal Ablative Radiotherapy in the Setting of Metastatic Renal Cell Carcinoma
Study Start Date : July 2009
Estimated Primary Completion Date : July 2020
Estimated Study Completion Date : July 2020

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Arm 1
Radiation: Radio-Ablation
Radiation: Radio-Ablation
Level I 20Gy/5 Level II 25Gy/5 Level III 30Gy/5 Level IV 35Gy/5 Level V 40Gy/5

Primary Outcome Measures :
  1. evaluate the safety/toxicity profile of renal radio-ablation in the setting of metastatic RCC [ Time Frame: After 3 patients have been seen at the 4 week follow up visit, ]
    toxicity will be assessed using CTCAE v3

Secondary Outcome Measures :
  1. Renal Function post renal radio-ablation [ Time Frame: 4,8,12 wk and every 6months x 5yr ]
    BUN, Creatinine

Other Outcome Measures:
  1. Tumour Response [ Time Frame: 4,8,12 wk and every 6 months x5yr. ]
    CT abdomen evaluting primary disease using RECIST criteria

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

Eligibility Criteria

  • Patients must have histologically confirmed carcinoma of the kidney
  • Patients must be able to tolerate extended treatment time 30 minutes for MVCT and treatment delivery) for radiation on the tomotherapy unit
  • Patients must have confirmed metastatic disease, nodal or locally advanced disease either by biopsy or imaging
  • Informed consent performed and documented
  • Patients must have one of a) unresectable local disease, b) be medically inoperable, or c) chosen against having a local surgical treatment
  • Age ≥ 18
  • Patients previously received any targeted therapy or immunotherapy for RCC, are also eligible. Patients must be off these agents for a minimum of 2 weeks prior to radiation therapy to be eligible

Exclusion Criteria:

  • Patients without an adequate functioning contralateral kidney as seen on renal perfusion scan (>40% of total renal flow)
  • Patients with poor baseline renal function, represented by a creatinine clearance < 50 mL/minute based on the Cockcroft-Gault approximation method
  • Patients with a creatinine clearance < 50 ml/minute are still eligible if the ipsilateral kidney has <25% of the total renal flow on a renal perfusion scan.

еCCr =140 - (Age) × Mass (in kilograms) × constant Serum creatinine ( in µmol/L) constant = male is 1.23, women is 1.04)

  • Previous abdominal radiotherapy
  • Bilateral RCC
  • Diagnosis of transitional cell carcinoma, squamous cell carcinoma, or a non epithelial cancer of the kidney
  • Diagnosis of any other malignancy in previous 5 years, excluding non-melanoma skin cancer -Known active malignancy other than RCC, excluding non-melanoma skin cancer
  • Estimated (by treating radiation oncologist) life expectancy of less than 8 weeks
  • Pregnant or breast-feeding women
  • Concurrent illness in addition to RCC that would make radiotherapy delivery unduly challenging, including but not limited to, severe congestive heart failure or other cardiorespiratory conditions, severe neuromuscular disorders, ongoing or active infections, and psychiatric illness
  • Medical conditions for which radiation is contraindicated, including but not limited to, scleroderma, systemic lupus erythematosus and ataxia teleangiectasia - Patients with excessive kidney motion on pre-planning 4D-CT scan that would prevent safe delivery of radiotherapy with gated or non-gated techniques
  • Patients taking concurrent medication that can interfere with the safe delivery of radiation (e.g. radiosensitizers)
  • Urology opinion recommends partial nephrectomy as cytoreductive atment --Expected TKI therapy to be initiated during initial 2 weeks completion of radiotherapy.

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): NCT02264548

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Canada, Ontario
London Regional Cancer Program of the Laswon Research Health Institue
London, Ontario, Canada, N6A 4L6
Sponsors and Collaborators
Lawson Health Research Institute
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Principal Investigator: Belal Ahmad, MD FRCPC London Regional Cancer Program of the Lawson Health Research Institute

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Belal Ahmad, Principal Investigator, Lawson Health Research Institute Identifier: NCT02264548     History of Changes
Other Study ID Numbers: Renal Ablation
First Posted: October 15, 2014    Key Record Dates
Last Update Posted: August 15, 2019
Last Verified: August 2019
Additional relevant MeSH terms:
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Carcinoma, Renal Cell
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Kidney Neoplasms
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Kidney Diseases
Urologic Diseases