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Single Application Brachytherapy in Cervical Cancer

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ClinicalTrials.gov Identifier: NCT03110497
Recruitment Status : Recruiting
First Posted : April 12, 2017
Last Update Posted : January 23, 2018
Sponsor:
Information provided by (Responsible Party):
Dr Umesh Mahantshetty, Tata Memorial Hospital

Brief Summary:
The purpose of the study is to evaluate safety and feasibility of single brachytherapy application with dose delivery in multiple fractions. Study will be conducted in Phase I/II clinical trial setting with strict Image guidance protocol.This study is expected reduce treatment duration and to increase ease and acceptability of brachytherapy in patients along with significant saving of resources

Condition or disease Intervention/treatment Phase
Cervical Cancer Radiation: Single application multi-fraction brachytherapy Not Applicable

Detailed Description:

Brachytherapy for cervical cancers has evolved a long way from the era of Manchester based point A prescription to volume-based prescription in the current era of 3 Dimensional (3D) imaging. Advancement in imaging technology and widespread availability of this technology has allowed most centers worldwide to incorporate Image guided brachytherapy as a routine part of their clinical practice.

The primary advantage of 3D image guided brachytherapy is that it allows the dose given by brachytherapy to conform to the anatomy of each individual patient while reducing the doses to organs at risk (OAR) (1). This technique has shown to improve local control rates and also reduce the rates of moderate to severe morbidity in multiple single institutional series (2-6). However, treatment related urinary and gastrointestinal late morbidity is still a significant problem with the 3 year actuarial incidence of intermediate to major morbidity (Grade≥2) being 30% and 29% for urinary and gastrointestinal side effects, respectively and Major morbidity (Grade≥3) is seen in 7% and 8%, respectively [An intErnational study on MRI guided BRachytherapy in locally Advanced CErvical cancers (EMBRACE) study 2014, work in progress(7)].

Most important factor determining late toxicities in radiotherapy is dose per fraction and total dose (total BEDGy3) rather than rate of dose accumulation or number of applications, which is evident from many trials of HDR brachytherapy.

The dose per fraction in the protocol of 9Gy, 7Gy and 7Gy HDR is effective in terms of local control rates and toxicities which has been published(8,9).

Our study is designed to evaluate the feasibility to deliver complete course of HDR brachytherapy in a single application while achieving dose constraints to OARs and keeping in account inter-fraction variation of doses to OAR's.

In the protocol proposed here, The Investigators intend to deliver fractionated treatments in a strict image based and quality controlled environment to minimize the doses to OAR's. Also if the constraints are not achieved, patients would be offered Standard brachytherapy regimen. This would ensure that the anticipated late toxicities would be minimized.

This study is expected to decrease overall treatment time and increase the ease and acceptability of brachytherapy in patients and with significant saving of resources while maintaining disease control rates and toxicity rates similar to standard protocols.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Intervention Model: Single Group Assignment
Intervention Model Description: Phase I/ Phase II single arm study
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Feasibility and Safety Study of Single Application Multi-fractionated High Dose Rate (HDR) Brachytherapy in Locally Advanced Cervical Cancer
Actual Study Start Date : September 17, 2017
Estimated Primary Completion Date : April 17, 2018
Estimated Study Completion Date : April 17, 2019

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Cervical Cancer

Arm Intervention/treatment
Experimental: Single application brachytherapy
After external beam radiotherapy with or without chemotherapy as per standard, each study patient will undergo single application brachytherapy to deliver 3 High Dose Rate (HDR) fractions [1st, 2nd and 3rd fractions of doses 9 Gy, 7 Gy and 7 Gy respectively] keeping 6-12 hours of interval. All patients will undergo an inter-fraction Computed Tomography (CT) scan before delivery of second fraction. Plan will be re-optimized to reduce the dose to Organs at Risk (OAR's), only if the dose exceeds the dose constraints. Dose constraints being exceedingly hard in 1st fraction or before 2nd fraction even after re-planning will deem patient non-feasible but optimization will be done to give preference to OAR's while accepting some compromise in target doses.
Radiation: Single application multi-fraction brachytherapy
Single application brachytherapy procedure to deliver high dose rate fractions of 9Gy, 7Gy and 7Gy with 6-12 hours apart under strict image guidance




Primary Outcome Measures :
  1. Number of participants achieving specified dosimetric constraints [ Time Frame: 1 year ]
    Number of participants achieving protocol specified dosimetric constraints will be measured, these dosimetric constraints are considered as a measure of safety. If not more than 20% of participants fail to achieve dosimetric constraints, trial will be considered feasible.


Secondary Outcome Measures :
  1. Number of participants with adverse events as assessed by CTCAE v 4.0 [ Time Frame: 2 years ]
    To assess toxicity outcomes in terms of treatment related late Gastrointestinal (GI) / Genitourinary (GU) / Vaginal toxicities (grade 3 or more)

  2. Local control rate [ Time Frame: 2 years ]
    Status of local disease at 2 years after treatment

  3. Percentage Inter-fraction dose variation [ Time Frame: 1 year ]
    To evaluate inter fraction dose variation for organs at risk



Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   Female
Gender Based Eligibility:   Yes
Gender Eligibility Description:   Study conducted for females with cervical cancer
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Histologically diagnosed invasive cervical cancer (squamous carcinoma, adenosquamous carcinoma, adenocarcinoma)
  • International Federation of Gynecology and Obstetrics (FIGO) stage 2b-4a after thorough clinical examination and work-up investigation
  • Suitable for radical radiation therapy with/without chemotherapy, and also for brachytherapy boost
  • Accepts the Informed consent process and signs the form on his/her will.

Exclusion Criteria:

  • Patients with vesico-vaginal fistula or recto-vaginal fistula at diagnosis
  • Patients at high risk of anaesthesia and patients with phobia /contra-indications to undergo MRI
  • Patients not suitable for brachytherapy
  • Metastatic disease beyond iliac on standard imaging
  • Vault cancers/recurrence
  • Previous history of pelvic radiation
  • Non-compliance to treatment
  • Medical or psychological illness precluding treatment protocol

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 ClinicalTrials.gov identifier (NCT number): NCT03110497


Contacts
Contact: Umesh Mahantshetty, MD, DNB 022 24177000 ext 7168 drumeshm@gmail.com

Locations
India
Tata Memorial Hospital Recruiting
Mumbai, Maharashtra, India, 400012
Contact: Umesh Mahantshetty, MD, DNB    +91 2224177000 ext 7168    mahantshettyum@tmc.gov.in   
Sponsors and Collaborators
Tata Memorial Hospital
Investigators
Principal Investigator: Umesh Mahantshetty, MD, DNB Professor, Department of Radiation oncology, Tata memorial Centre, Mumbai

Additional Information:
Publications:
Shrivastava S DK, Mahantshetty U, Engineer R, Patil N, Deshpande D, Tongaonkar H Comparing Low-Dose-Rate andHigh-Dose-Rate Intracavitary Brachytherapy in Carcinoma Cervix: Results From a Randomized Controlled Study. . Int J Radiat Oncol Biol Phys 2006, 1; 66.

Responsible Party: Dr Umesh Mahantshetty, Professor, Tata Memorial Hospital
ClinicalTrials.gov Identifier: NCT03110497     History of Changes
Other Study ID Numbers: TMH-1759
REF/2017/03/013733 ( Registry Identifier: Clinical Trial Registry - India )
First Posted: April 12, 2017    Key Record Dates
Last Update Posted: January 23, 2018
Last Verified: January 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Dr Umesh Mahantshetty, Tata Memorial Hospital:
Cervical cancer
Image guided Brachytherapy
single application

Additional relevant MeSH terms:
Uterine Cervical Neoplasms
Uterine Neoplasms
Genital Neoplasms, Female
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Uterine Cervical Diseases
Uterine Diseases
Genital Diseases, Female