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Intraoperative Radiation Therapy for Resectable Pancreas Cancer (IORT)

This study is currently recruiting participants.
See Contacts and Locations
Verified April 2017 by Tarita Thomas, Loyola University
Sponsor:
Information provided by (Responsible Party):
Tarita Thomas, Loyola University
ClinicalTrials.gov Identifier:
NCT02599662
First received: November 5, 2015
Last updated: April 19, 2017
Last verified: April 2017
  Purpose

Currently, for patients with pancreatic cancer the standard treatment is surgery followed by chemotherapy and/or radiation therapy. An investigational approach is to perform the surgery and treat the area of the tumor with intraoperative radiotherapy in one procedure. Intraoperative radiation delivers low energy x-rays to a targeted area during the time of tumor removal.

The purpose of this study is to learn about both the good and bad effects of adding intraoperative radiation therapy. Another goal is to determine and compare the quality of life before and after the procedure. We will also monitor the effect of the therapy on the cancer lesion and any complications that may result.


Condition Intervention Phase
Pancreas Cancer Radiation: 10 Gy Low-KV IORT Radiation: 15 Gy Low-KV IORT Radiation: 20 GY Low-KV IORT Phase 1

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: No masking
Primary Purpose: Treatment
Official Title: Phase I Study of Low Kilovoltage Intraoperative Radiation for Patients With Resectable Pancreatic Adenocarcinoma

Resource links provided by NLM:


Further study details as provided by Tarita Thomas, Loyola University:

Primary Outcome Measures:
  • Maximum Tolerated Dose [ Time Frame: 52 weeks ]
    Maximum Tolerated Dose as defined by Radiation-related acute Grade 3-5 toxicity in greater than or equal to 2 patients out of 6 patients at any dose level


Secondary Outcome Measures:
  • QOL surveys [ Time Frame: 52 weeks ]
    . The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQC30) 30 item questionnaire to evaluate cancer patients' physical, psychological, and social functioning. Patients are asked to rate symptoms on a YES or NO scale; a 4 point scale ranging from 1 (Not at all) to 4 (Very much); and a 7 point scale ranging 1 (Very poor) to 7 (Excellent)


Estimated Enrollment: 12
Study Start Date: January 2015
Estimated Study Completion Date: January 2019
Estimated Primary Completion Date: January 2018 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Group 1: 10 Gy Low-KV IORT
10 Gy Low Kilovoltage Intraoperative Radiation: intraoperative low-kV IORT will be delivered as a single dose of 10 Gy at 2 millimeter depth. Doses will be escalated in increments of 5 Gy until completion of 20 Gy dose level or the DLT is reached and MTD is realized.
Radiation: 10 Gy Low-KV IORT
: intraoperative low-kV IORT will be delivered as a single dose of 10 Gy at 2 millimeter depth. Doses will be escalated in increments of 5 Gy until completion of 20 Gy dose level or the DLT is reached and MTD is realized.
Group 2: 15 Gy Low-KV IORT
15 Gy Low Kilovoltage Intraoperative Radiation: intraoperative low-kV IORT will be delivered as a single dose of 15 Gy at 2 millimeter depth. Doses will be escalated in increments of 5 Gy until completion of 20 Gy dose level or the DLT is reached and MTD is realized.
Radiation: 15 Gy Low-KV IORT
intraoperative low-kV IORT will be delivered as a single dose of 15 Gy at 2 millimeter depth. Doses will be escalated in increments of 5 Gy until completion of 20 Gy dose level or the DLT is reached and MTD is realized.
Group 3: 20 GY Low-KV IORT
20 GY Low Kilovoltage Intraoperative Radiation: intraoperative low-kV IORT will be delivered as a single dose of 20 Gy at 2 millimeter depth. Patients will be accrued to this group until the DLT is reached and MTD is realized.
Radiation: 20 GY Low-KV IORT
intraoperative low-kV IORT will be delivered as a single dose of 20 Gy at 2 millimeter depth. Patients will be accrued to this group until the DLT is reached and MTD is realized.

Detailed Description:

The purpose of this study is to determine safety of low kilovoltage radiotherapy delivery of a focused dose of radiation to the areas at high risk for locoregional recurrence following pancreaticoduodenectomy. This surgery is currently the only potentially curative approach for patients with pancreatic cancer. Unfortunately, following surgery alone >50% of patients will have a local recurrence of disease [5]. Local control will become increasingly important as chemotherapy regimens continue to improve the distant metastases-free survival. Intraoperative radiation therapy allows direct access to the tumor bed and areas of concern while allowing displacement and shielding of normal tissue and organs at risk of radiation toxicity.

Study Objectives The primary objective is to determine the maximum tolerated dose (MTD) for low kilovoltage (kV) intraoperative radiotherapy (IORT)

The secondary objectives are:

To develop acute and chronic toxicity profiles for this treatment modality

To determine the feasibility of including low-kV IORT in the treatment of pancreatic cancer

To evaluate the following physics and delivery parameters: treatment prescription dose, depth of treatment, applicator type, and treatment time.

To measure patient's quality of life (QOL) before and after treatment, including change in pain level and fatigue level.

To describe the disease specific outcomes of local regional control, progression free-survival, distant metastasis free-survival, disease free-survival and overall survival associated with low-kV IORT following pancreaticoduodenectomy.

  Eligibility

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

Inclusion Criteria:

  • Pathologically confirmed pancreatic adenocarcinoma.
  • Age ≥ 18 years.
  • Performance status ECOG 0-1.
  • Patient must have resectable disease. In order to be resectable the following criteria must be met:
  • Absence of distant metastases.
  • Clear fat planes around the celiac axis, hepatic artery, and superior mesenteric artery .
  • Absence of direct involvement of inferior vena cava or aorta.
  • Stage I and stage II disease per AJCC 7th edition.
  • Complete history and physical examination including weight and ECOG performance status within 31 days of entry.
  • Laboratory data obtained ≤ 14 days prior to registration on study, with adequate bone marrow and organ function defined as follows:

Laboratory Test Result Leukocytes ≥3000/mm3 Absolute Neutrophil Count (ANC) ≥1500/mm3 Platelets ≥100,000/mm3 Total Bilirubin ≤1.4 mg/dL AST(SGOT),ALT(SPGT) ≤2.5 x institutional upper limit of normal Serum creatinine ≤1.4 mg/dL INR ≤1.5 BUN < 20 mg/dL Albumin ≥3.5 g/dL

  • Negative serum pregnancy test for females of childbearing potential within 14 days of study registration. Should a female participant become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  • A female of child-bearing potential is any woman (regardless of sexual orientation, having undergone tubal ligation, or remaining celibate by choice) who meets the following criteria:

    • Has not undergone a hysterectomy or bilateral oophorectomy; or
    • Has not been naturally postmenopausal for at least 12 consecutive months.
  • Abdominal CT scan with contrast prior to performance of surgery. If patient is allergic to contrast an abdominal MRI may substitute. Other imaging may be added or substituted as deemed appropriate by the treatment team (surgeon, radiation oncologist, medical oncologist).
  • Ability to understand and the willingness to sign a written informed consent.
  • Signed study specific informed consent.
  • Patients with prior history of malignancy are permitted to register in the study as long as they are not actively taking cytotoxic or biologic medication for treatment of the prior malignancy. Patient must be disease-free from any malignancy for at least the previous 6 months and must have no history of brain metastases.
  • Consultation, agreement, and documentation by a radiation oncologist that the patient is suitable to receive radiotherapy per this protocol.
  • Consultation, agreement, and documentation by surgeon that the patient is a suitable surgical candidate.
  • Consultation, agreement, and documentation by an anesthesiologist that patient is suitable to receive general anesthesia.

Exclusion Criteria:

  • Defined treatment area which cannot be adequately covered by the radiation field as defined by the radiation oncology treatment team.
  • Patients who have received neoadjuvant chemotherapy are ineligible.
  • Patients with Stage III-Stage IV disease.
  • Patients who have been on an immunosuppressive agent (excluding corticosteroids) within 4 weeks of the proposed operation.
  • Patients receiving any other investigational agents.
  • Current pregnancy or currently nursing.
  • History of brain metastases.
  • Severe, active comorbidity defined as follows
  • Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months. [23]
  • Myocardial infarction within 3 months of study registration [23].
  • Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration.
  • Chronic Obstructive Pulmonary Disease or other respiratory illness hospitalization or precluding study therapy at time of registration [23].
  • Uncontrolled diabetes which in the opinion of any of the patient's physicians requires an immediate change in management. A patient may be considered eligible if the patient's physician managing the diabetes deems the appropriate changes in management have resulted in adequate control. [23].
  • BMI >30.
  • Patient with active diagnosis of a bleeding disorder. [23]
  • Patients enrolled in another interventional clinical trial.
  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 ClinicalTrials.gov identifier: NCT02599662

Contacts
Contact: Beth Chiappetta, BSN 708-216-2568 bchiappetta@lumc.edu
Contact: Tarita Thomas, MD, PhD 708-216-2571 tathomas@lumc.edu

Locations
United States, Illinois
Loyola University Medical Center Recruiting
Maywood, Illinois, United States, 60153
Contact: Beth Chiappetta, BSN    708-216-2568    bchiappetta@lumc.edu   
Contact: Tarita Thomas, MD,PhD    708-216- 2571    tathomas@lumc.edu   
Sponsors and Collaborators
Loyola University
  More Information

Publications:

Responsible Party: Tarita Thomas, Assistant Professor of Radiation Oncology, Loyola University
ClinicalTrials.gov Identifier: NCT02599662     History of Changes
Other Study ID Numbers: 207194
20719412115 ( Other Identifier: Loyola University IRB )
Study First Received: November 5, 2015
Last Updated: April 19, 2017

Keywords provided by Tarita Thomas, Loyola University:
Cancer
Intraoperative Radiation Therapy - IORT

Additional relevant MeSH terms:
Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Endocrine Gland Neoplasms
Digestive System Diseases
Pancreatic Diseases
Endocrine System Diseases

ClinicalTrials.gov processed this record on July 21, 2017