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Dose Escalation by Boosting Radiation Dose Within the Primary Tumor Using FDG-PET-CT Scan in Stage IB, II and III NSCLC (PET Boost)

This study is currently recruiting participants. (see Contacts and Locations)
Verified January 2017 by The Netherlands Cancer Institute
European Union
Information provided by (Responsible Party):
The Netherlands Cancer Institute Identifier:
First received: December 1, 2009
Last updated: January 19, 2017
Last verified: January 2017

Increasing ("boosting") the radiation dose for patients with non-small cell lung carcinoma to the individual maximal dose which can safely be given. The question is if patients should receive this boost on the whole tumor on part of the tumor. Therefore patients are randomized for one of these two treatment options. All patients will receive 24 radiations. Dose increasement will be enabled by a so called integrated boost.


- PET imaging of hypoxia using [18F]HX4, single injection and then PET CT scanning two and four hours post injection.

Condition Intervention
Radiation: Radiotherapy

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: No masking
Primary Purpose: Treatment
Official Title: Dose Escalation by Boosting Radiation Dose Within the Primary Tumor on the Basis of a Pre-treatment FDG-PET-CT Scan in Stage IB, II and III NSCLC: a Randomized Phase II Trial

Resource links provided by NLM:

Further study details as provided by The Netherlands Cancer Institute:

Primary Outcome Measures:
  • Local progression-free survival at 1 year [ Time Frame: 1 year ]

Secondary Outcome Measures:
  • Toxicity [ Time Frame: 1 year ]
  • Overall survival [ Time Frame: 1 year ]
  • Quality of life [ Time Frame: 1 year ]

Estimated Enrollment: 168
Study Start Date: May 2010
Estimated Study Completion Date: November 2017
Estimated Primary Completion Date: September 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Whole tumor boost
Patients in this arm will receive radiotherapy (66Gy) in 24 fractions of 2.75 Gy with an integrated boost to the primary tumor as a whole
Radiation: Radiotherapy
Boost 50% SUV area
Patients in this arm receive radiotherapy (66Gy) in 24 fractions of 2.75Gy with an integrated boost to the 50% SUVmax area of the primary tumor (of the pre-treatment FDG-PET-CT scan)
Radiation: Radiotherapy

Detailed Description:

A randomized phase II study will be conducted in patients with inoperable stage IB, II or III non-small cell lung cancer (NSCLC). The patients will be randomized to receive the standard 66 Gy given in 24 fractions of 2.75 Gy with an integrated boost to the primary tumor as a whole (Arm A) or with an integrated boost to the 50% SUVmax area of the primary tumor (of the pre-treatment FDG-PET scan) (Arm B). Both treatment arms may be combined with chemotherapy (concurrent or sequential). Patients fulfilling the eligibility criteria will be registered in the study, and an initial radiotherapy treatment planning will be performed. When an integrated boost to the primary tumor as a whole up to 72 Gy is not possible because of dose constraints, the patient will receive 66 Gy or lower according to the normal tissue tolerance (see below). They will not be randomized, but will be followed in the trial. As such, it will be clear which proportion of patients can receive an integrated boost and what the outcome is when dose-escalation is not possible.

Stage IB-II patients receive radiotherapy alone, and stage III patients combined chemotherapy and radiation. The patients may have received induction chemotherapy up to two cycles before registration in this trial. The statistical calculations have been performed to deal with this patient heterogeneity.

The primary objective of this study is to determine the local progression-free survival (LPFS)at 1 year.

Secondary objectives will be

  • Toxicity as a function of radiotherapy dose and volume of the tissue irradiated.
  • Overall survival.
  • Quality of life


  • PET imaging of hypoxia using [18F]HX4, single injection and then PET CT scanning two and four hours post injection.
  • Dynamic Contrast-Enhanced CT imaging

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

Inclusion Criteria:

  1. Patients > 18 years with any subtype of pathologically proven (biopsy or cytology), non-small cell lung cancer. The diagnosis may be established from biopsy or cytology obtained from the primary tumor and/ or from metastatic lymph nodes.
  2. Minimal diameter of the primary tumor 4 cm, this to allow for boosting of sub-volumes.
  3. UICC TNM Stage T2-4, N0-3, M0 disease (TNM definition see appendix 2).
  4. Only stage IB-II patients who are nog candidates for surgery are study candidates.
  5. Measurable disease at registration.
  6. ECOG-performance status ≤ 2 (see appendix 6)
  7. Lung function: FEV1 and DLCO at least 40 % of the age-adjusted normal value
  8. Willing and able to give a written informed consent.
  9. Patients with locoregional recurrent lung tumor following surgery or a second primary cancer (at least 3 years after treatment) are eligible, unless a pneumonectomy was performed.
  10. SUVmax in the pre-treatment FDG-PET scan ≥ 5 for the primary tumor.
  11. Adequate organ function, including the following:

    • Adequate bone marrow reserve: absolute neutrophil (segmented and bands) count (ANC) ≥ 1.5 x 109/L, platelets ≥ 100 x 109/L, and hemoglobin ≥ 9 g/dL.
    • Hepatic: bilirubin ≤ 1.5 times the upper limit of normal (x ULN); alkaline phosphatase (AP), aspartate aminotransferase (ASAT), and alanine aminotransferase (ALAT) ≤ 3.0 x ULN (AP, AST, and ALT ≤ 5 x ULN is acceptable if liver has tumor involvement).
    • Renal: calculated creatinine clearance (CrCl) ≥ 45 ml/min based on the original weight based Cockcroft and Gault formula
  12. For women: Must be surgically sterile, postmenopausal, or compliant with a highly reliable contraceptive method (failure rate <1%) during and for 6 months after the treatment period; must have a negative serum or urine pregnancy test within 7 days before study enrollment and must not be breast-feeding.
  13. For men: Must during chemotherapy take adequate contraceptive measures.

Exclusion Criteria:

  1. Prior radiotherapy to the thorax.
  2. Clinical superior vena cava syndrome, malignant pleural effusion or malignant pericardial effusion.
  3. T4, specified as:Tumor growth in large blood vessels on spiral CT scan or encasement >50%
  4. multiple nodules in the same or ipsilateral lobe(s).
  5. Post-obstructive atelectasis or infiltration that cannot be distinguished from tumor on a CT-PET scan.
  6. Patients with a diagnosis of other cancer within the last 3-years (except in situ carcinoma's and / or non-melanoma skin cancer).
  7. Pregnant women, lactating women
  Contacts and Locations
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, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01024829

Contact: Jose Belderbos, MD, PhD +31 20 512 9111
Contact: Dirk De Ruysscher, MD, PhD +31 88 44 55 666

University Hospital Leuven, campus Gasthuisberg Recruiting
Leuven, Belgium, B-3000
Contact: Maarten Lambrecht, MD, PhD    + 32 16346902   
Principal Investigator: Maarten Lambrecht, MD, PhD         
Rigshospitalet Recruiting
Copenhagen, Denmark, 2100
Contact: Gitte Persson, MD, PhD    +45 35454391   
Principal Investigator: Gitte persson, MD, PhD         
MAASTRO clinic Recruiting
Maastricht, Limburg, Netherlands, 6229 ET
Contact: Bart Reymen, MD, PhD    +31 88 44 55 776   
Contact: Dirk de Ruysscher    +31 88 44 55 776   
Principal Investigator: Bart Reymen, MD, PhD         
NKI/AVL Recruiting
Amsterdam, Netherlands, 1066CX
Contact: Jose Belderbos, MD, PhD    +31 20 512 9111   
Contact: Judi van Diessen, MD    +31 20 512 9111   
Principal Investigator: José Belderbos         
Academic Medical Centre Recruiting
Amsterdam, Netherlands, 1105AZ
Contact: Edith Dieleman, MD, PhD    + 31 20 566 7990   
Contact: Willemijn Kolff, MD    + 31 20 566 3433   
Karolinska Hospital Recruiting
Stockholm, Sweden
Contact: Hedvig Bjorkestrand, MD, PhD   
Principal Investigator: Hedvig Bjorkestrand, MD, PhD         
United Kingdom
The Christie NHS Foundation Trust Recruiting
Manchester, United Kingdom, M20 4BX
Contact: Corinne Faivre-Finn, MD, PhD    +44(0) 1614468200   
Sponsors and Collaborators
The Netherlands Cancer Institute
European Union
Principal Investigator: José Belderbos, MD, PhD NKI-AvL
  More Information

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: The Netherlands Cancer Institute Identifier: NCT01024829     History of Changes
Other Study ID Numbers: PET Boost
Study First Received: December 1, 2009
Last Updated: January 19, 2017
Individual Participant Data  
Plan to Share IPD: No

Keywords provided by The Netherlands Cancer Institute:
Non small cell lung cancer
HX4 processed this record on May 22, 2017