Proton Beam Irradiation for the Treatment of Unresectable Hepatocellular Cancer and Cholangiocarcinoma

• ClinicalTrials.gov Identifier: NCT00976898
• Recruitment Status: Completed
• First Posted: September 15, 2009
• Results First Posted: January 31, 2018
• Last Update Posted: August 15, 2018
• Sponsor: Massachusetts General Hospital
• Collaborators: Dana-Farber Cancer Institute; Brigham and Women's Hospital; National Cancer Institute (NCI); M.D. Anderson Cancer Center; University of Pennsylvania
• Information provided by (Responsible Party): Theodore Sunki Hong, Massachusetts General Hospital

Study Description

Brief Summary:

In this study the investigators will be studying the effects of proton beam radiation therapy. This is a very accurate kind of treatment that has been shown to affect less normal tissue than a photon radiation beam. The accuracy allows the investigators to more safely increase the amount of radiation delivered to eliminate cancer. This accuracy will potentially reduce side effects that participants would normally experience using photon radiation therapy. The purpose of this study is to determine if radiation using proton beam therapy will kill the cancer cells in the participants liver.

Condition or disease	Intervention/treatment	Phase
Liver Cancer	Radiation: Proton Beam Irradiation	Not Applicable

Detailed Description:

• Participants will receive treatment as an outpatient in the Francis H. Burr Proton Center at the Massachusetts General Hospital, the MD Anderson Proton Therapy Center or the Roberts Proton Therapy Center at the University of Pennsylvania.
• Not everyone who participates in this study will be receiving the same dose of radiation. The dose received will be determined by the location of the tumor(s) within the liver.
• Proton Beam radiation therapy to the liver will be given once a day, 5 days a week (Monday-Friday), for 2 weeks.
• The following procedures will be performed once a week during treatment on days 1, 8 and 15, as well as on the last day of radiation: physical examination and blood tests.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 83 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase II Study of Proton Beam Irradiation for the Treatment of Unresectable Hepatocellular Cancer and Cholangiocarcinoma
• Study Start Date: August 2009
• Actual Primary Completion Date: March 2017
• Actual Study Completion Date: July 2018

Arms and Interventions

Arm	Intervention/treatment
Experimental: Proton Beam Irradiation; This is a single arm study. All study participants will receive proton radiation therapy.	Radiation: Proton Beam Irradiation; Given once a day, 5 days a week, for 3 weeks

Outcome Measures

Primary Outcome Measures :

1. 2 Year Local Control Rate [ Time Frame: 2 years ]
   The percentage of participants with local control after two years as assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.0. The duration of control was measured from the start of treatment. Local control is the absence of local failure. Local Failure is defined as evidence of tumor growth/regrowth in any direction beyond that present of the pre-treatment imaging studies in the treated lesion(s).
2. Median Overall Survival [ Time Frame: 5 years ]
   The median survival time in months as measured from the start of treatment until death due to any cause or until the participants is censored. Participants are censored at the date of their last follow-up.

Secondary Outcome Measures :

1. Number of Participants With Treatment Related Adverse Events ≥ Grade 3 [ Time Frame: 2 years ]
   Summary of the proton radiation related grade 3 or greater adverse events that participants experienced. Adverse events were assessed using Common Terminology Criteria for Adverse Events (CTCAE v3).
2. Patterns of Failure [ Time Frame: 2 years ]
   A summary of the patterns of treatment failure, shown as the number of participants that fall into each category at the end of study follow-up

Eligibility Criteria

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

Criteria

Inclusion Criteria:

• Biopsy proven unresectable or locally recurrent hepatocellular cancer or intrahepatic cholangiocarcinoma. Patients with a single lesion must be 12cm or less in greatest dimension. For patients with two lesions, no lesion may be greater than 10cm in greatest dimension. For patients with three lesions, no lesion may be greater than 6cm in greatest dimension. Patients may have single or multinodular tumors (up to 3). There must be no evidence of extrahepatic tumor. Portal vein involvement or thrombosis is allowed.
• Participants must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as 20mm or greater with conventional techniques or as 10mm or greater with spiral CT scan.
• Patients may have had prior chemotherapy, targeted biological therapy, surgery, transarterial chemoembolization (TACE), radiofrequency ablation, or cryosurgery for their disease as long as it is greater than 4 weeks from first protocol radiation treatment (6 weeks for nitrosoureas or mitomycin C). Patients may not have had prior radiation to the affected area.
• 18 years of age or older
• Expected survival must be greater than three months
• ECOG Performance Status of 0, 1 or 2
• Normal organ and marrow function as outlined in the protocol
• If patient has underlying cirrhosis, only Child-Pugh classification Group A or Group B patients should be included in this study.
• Patients must be either surgically sterile or post-menopausal. Male and female patients of child-bearing potential must agree to use adequate contraception prior to study entry and for the duration of the study participation.
• Individuals with a history of other malignancies are eligible if they have been disease-free for at least 5 years and are deemed by the investigator to be at low risk for recurrence of that malignancy. Individuals with the following cancers are eligible if diagnosed and treated within the past 5 years: cervical cancer in situ, and basal cell or squamous cell carcinoma of the skin

Exclusion Criteria:

• Women who are pregnant or lactating
• Patients with evidence of non-hepatic metastatic disease
• Local conditions or systemic illnesses which would reduce the local tolerance to radiation treatment, such as serious local injuries, active collagen vascular disease, etc.
• Prior liver directed radiation treatment
• Patients may have no serious medical illness, which may limit survival to less than 3 months
• Patients may have no serious psychiatric illness/social situations which would limit compliance with study requirements
• Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
• Patients may not be receiving any other study agents
• Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia.

Contacts and Locations

Locations

United States, Massachusetts

Massachusetts General Hospital

Boston, Massachusetts, United States, 02114

Dana-Farber Cancer Institute

Boston, Massachusetts, United States, 02115

United States, Pennsylvania

University of Pennsylvania, Roberts Proton Facility

Philadelphia, Pennsylvania, United States

United States, Texas

University of Texas MD Anderson Cancer Center

Houston, Texas, United States, 77030

Sponsors and Collaborators

Massachusetts General Hospital

Dana-Farber Cancer Institute

Brigham and Women's Hospital

National Cancer Institute (NCI)

M.D. Anderson Cancer Center

University of Pennsylvania

Investigators

• Principal Investigator: Theodore S. Hong, MD; Massachusetts General Hospital

  Study Documents (Full-Text)

Documents provided by Theodore Sunki Hong, Massachusetts General Hospital:

Study Protocol and Statistical Analysis Plan  [PDF] November 16, 2015

More Information

• Responsible Party: Theodore Sunki Hong, Attending Radiation Oncologist, Massachusetts General Hospital
• ClinicalTrials.gov Identifier: NCT00976898
• Other Study ID Numbers: 09-131; P01CA021239 ( U.S. NIH Grant/Contract )
• First Posted: September 15, 2009
• Results First Posted: January 31, 2018
• Last Update Posted: August 15, 2018
• Last Verified: July 2018

Keywords provided by Theodore Sunki Hong, Massachusetts General Hospital:

proton beam radiation

Additional relevant MeSH terms:

Liver Neoplasms; Cholangiocarcinoma; Carcinoma, Hepatocellular; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Liver Diseases; Adenocarcinoma; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type