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Trial record 51 of 418 for:    mesothelioma

Accelerated Hypofractionated Radiotherapy in the Treatment of Malignant Pleural Mesothelioma (MesoRT)

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ClinicalTrials.gov Identifier: NCT03269227
Recruitment Status : Recruiting
First Posted : August 31, 2017
Last Update Posted : November 9, 2018
Sponsor:
Information provided by (Responsible Party):
Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori

Brief Summary:

This is a monocentric prospective study of radiotherapy using accelerated hypofractionation with Tomotherapy in Malignant Pleural Mesothelioma (MPM) patients after pleurectomy / decortication (P / D) or biopsy.

The treatment will be delivered using Tomotherapy, that allows to adopt dose accelerated hypofraction criteria. Treatment duration is 5 consecutive days.


Condition or disease Intervention/treatment Phase
Malignant Pleural Mesothelioma Radiation: Accelerated hypofractionation with Tomotherapy Not Applicable

Detailed Description:

The role of radiation therapy remains to be defined in unresected MPM or after P/D. For the latter, local control remains the primary objective but radiotherapy (RT) is a challenge because of the risk of pneumonia in the intact lung. There are no specific clinical data to support the use of adjuvant radiation therapy after P/D or definitive radiation therapy after biopsy-based diagnosis for patients not amenable to surgery.

However, recent publications on Intensity Modulated Radiotherapy (IMRT) and conventional fractionation after P/D or biopsy have shown the feasibility and acceptable toxicity profile of the treatment.

The investigators submitted a retrospective analysis of accelerated hypofractionated Intensity modulated arc therapy (IMAT) using TomoTherapy in MPM following P/D or diagnostic biopsy. In the investigators experience of MPM, treatment of the intact lung with pleural IMAT using helical Tomotherapy is a safe and feasible option with an acceptable lung toxicity profile. The results obtained in terms of toxicity were encouraging. In fact, the investigators only observed one case of G3 pneumonia, and the patient in question is still alive and off oxygen therapy. Patient compliance with this short-course treatment was also very good.

Overall, the investigators found that accelerated hypofractionation with IMAT was feasible at the dose delivered and had an acceptable toxicity profile. So the investigators want to propose this protocol for treatment of MPM in intact lung to improve local control.

In patients with malignant pleural mesothelioma who underwent pleurectomy / decortications (P/D) or only diagnostic biopsy, it is difficult to deliver a tumoricidal dose of radiation to the pleura due to the presence of the ipsilateral lung. In recent years, the investigators have implemented a technique for irradiation of the pleura in intact lung, using accelerated hypofractionation with Tomotherapy in an attempt to reduce as far as possible, the dose to the ipsilateral lung. The aim of the treatment was palliation. The investigators analyzed the data of 36 patients with MPM, with a long follow-up without recording death cases related to radiation treatment or radiation pneumonitis grade 4.

In view of these data, the aim of this study is to increase the dose of treatment in patients suffering from MPM after P/D or biopsy.

The study will evaluate the feasibility of the treatment through the study of pulmonary acute and late toxicity; The treatment will be delivered using Tomotherapy that allows to adopt dose accelerated hypofraction criteria. Treatment duration is 5 consecutive days.


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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: Accelerated Hypofractionated Radiotherapy in the Treatment of Malignant Pleural Mesothelioma
Actual Study Start Date : August 14, 2017
Estimated Primary Completion Date : July 2020
Estimated Study Completion Date : July 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Mesothelioma

Arm Intervention/treatment
Experimental: Accelerated hypofractionation with Tomotherapy

Tomotherapy Treatment Planning System (TPS) will be used for treatment plannings.

Patient' set-up daily control through Tomo-image (CT megavoltage) immediately before each sitting of all the patients.

Prescription dose to the target: 30 Gy in 5 daily fraction (at the reference isodose 60-70%) with an internal increasing inhomogenous dose of up to 37.5 Gy-40 Gy for Gross Tumor Volume (GTV).

Radiation: Accelerated hypofractionation with Tomotherapy

Tomotherapy TPS will be used for treatment plannings. Patient' set-up daily control through Tomo-image (CT megavoltage) immediately before each sitting of all the patients.

Prescription doses:

Prescription dose to the target: 30 Gy in 5 daily fraction (at the reference isodose 60-70%) with an internal increasing inhomogenous dose of up to 37.5 Gy-40 Gy for GTV.

Steroids (methylprednisolone 4 mg daily) should be used from day 1 of radiotherapy to day + 30 after the end of the treatment.





Primary Outcome Measures :
  1. Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] [ Time Frame: up to 36 months ]
    Acute and late toxicity evaluation by Common Terminology Criteria for Adverse Events (CTCAE) version 4.03, performing strumental tests (CT scan, spirometry) to evaluate adverse events including pulmonary toxicity


Secondary Outcome Measures :
  1. Overall survival (OS) [ Time Frame: up to 36 months ]
    time from randomization until death for any cause

  2. Disease control rate (DCR) [ Time Frame: up to 36 months ]
    the assessment of disease control rate (DCR) defined as proportion of patients with complete response (CR), partial response (PR) and stable disease (SD) for patients with evaluable disease using the Modified RECIST criteria for assessment of response in malignant pleural mesotelioma

  3. time to progessione (TTP) [ Time Frame: up to 36 months ]
    calculation of time to progression (TTP) for patients without evidence of disease or with not evaluable disease



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patients must have histologically or cytologically confirmed MPM
  2. Karnofsky Performance status scale 70-100 (see Appendix B)
  3. Male or female, Aged >= 18 and ≤ 85 years
  4. Life expectancy greater than 6 months
  5. All clinical and pathological stage with the exclusion of contralateral mediastinum involvement (N3) and M1
  6. Patients must have normal organ and marrow function as defined below:

    • leukocytes >3,000/microL
    • absolute neutrophil count >1,500/microL
    • platelets >100,000/microL
    • aspartate transaminase(AST)/alanine transaminase (ALT) <2.5 X institutional upper limit of normal
    • creatinine within normal institutional limits
    • glycemia < 100 mg/dl
  7. Ability to understand and the willingness to sign a written informed consent document.
  8. Forced expiratory volume in the 1st second(FEV1) ≥ 50
  9. Patients after biopsy must have measurable disease defined as at least one lesion that can be accurately measured according to modified RECIST criteria; for resected patients no more than 3 months are allowed for RT start.
  10. Written informed consent signed and dated before starting study procedure.
  11. Female participants of child bearing potential and male participants whose partner is of child bearing potential must be willing to ensure that they or their partner use effective contraception during the study and for 4 months thereafter.

Exclusion Criteria:

  1. Previous thorax radiotherapy
  2. Chemotherapy is allowed but completed 3 weeks before RT starts
  3. Participation in another clinical trial with any investigational agents within 30 days prior to study screening.
  4. Patients with M1 have to be excluded to this study
  5. FEV1 < 50
  6. Age >85 years old
  7. Respiratory needing oxygen therapy
  8. Interstitial pneumopathy
  9. Active pneumonitis
  10. Fissural disease
  11. Contralateral mediastinum involvement (N3) and M1
  12. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would 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 ClinicalTrials.gov identifier (NCT number): NCT03269227


Contacts
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Contact: Oriana Nanni +39 0543 739266 oriana.nanni@irst.emr.it

Locations
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Italy
SC Radiotherapy Recruiting
Meldola, Italy, 47014
Contact: Elisabetta Parisi, MD    0543 7391100    elisabetta.parisi@irst.emr.it   
Sponsors and Collaborators
Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori
Investigators
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Study Director: Elisabetta Parisi, MD Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Via Maroncelli 40, 47014 Meldola, ITALY

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Responsible Party: Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori
ClinicalTrials.gov Identifier: NCT03269227     History of Changes
Other Study ID Numbers: IRST163.01
First Posted: August 31, 2017    Key Record Dates
Last Update Posted: November 9, 2018
Last Verified: November 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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

Keywords provided by Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori:
Malignant Pleural Mesothelioma
Radiotherapy
Tomotherapy
Hypofractionation

Additional relevant MeSH terms:
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Mesothelioma
Adenoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Mesothelial