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Neoadjuvant Irradiation of Extremity Soft Tissue Sarcoma With Ions (EXTREM ION)

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ClinicalTrials.gov Identifier: NCT04946357
Recruitment Status : Recruiting
First Posted : June 30, 2021
Last Update Posted : July 2, 2021
Sponsor:
Information provided by (Responsible Party):
Juergen Debus, University Hospital Heidelberg

Study Description
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Brief Summary:
This randomized prospective open-label phase 2 trial testes the safety and feasibility of a hypofractionated accelerated neoadjuvant proton or carbon ion radiotherapy based on the rate of wound healing disorders from beginning of radiotherapy to maximum 120 days after the planned tumor resection or discontinuation of treatment due to any reason. The treatment is of shorter duration (2-3 weeks vs. 5 weeks standard treatment), which should please most patients and thus enhance quality of life. The treatment regimen furthermore promises a reduced rate of late side effects and significant optimization of the current treatment standards. A phase II trial is mandatory not only for obtaining the safety and feasibility data, but also in order to prepare a concurrent phase III trial. Due to the low incidence of soft tissue sarcoma, only a well prepared multicenter study has a chance to be successfully completed based on previous experiences in trials for seldom tumor entities.

Condition or disease Intervention/treatment Phase
Soft Tissue Sarcoma Radiation: Protons Radiation: carbon ions Not Applicable

Detailed Description:

Oncologic complete local excision (wide resection) combined with radiotherapy forms the standard treatment for patients with soft tissue sarcoma. Especially patients with G2/G3 sarcomas profit from the combination of radiotherapy and surgery. Well-differentiated sarcomas (G1) after total resection (R0) receive no subsequent treatment besides surgery. The sequence of surgery and radiation therapy is widely discussed by the radiation oncologists and surgeons. The main advantages of neoadjuvant (pre-operative) radiotherapy are the smaller treatment target volumes and reduced prescribed radiation doses of 50 Gy vs. 66 Gy (postoperative) in 2 Gy single doses. Thus, due to these reductions in volumes and dose, neoadjuvant radiotherapy is associated with a lower rate of radiotherapy-associated edema and fibrosis. However, a randomized phase III study showed an increased rate of wound healing complications in patients with neoadjuvant radiotherapy compared to adjuvant (post-operative) radiotherapy (35% vs. 17%). For this reason, adjuvant radiotherapy in is currently preferred in cases with good operability.

Particle therapy bears the chance to utilize the advantages of preoperative radiotherapy without compromising wound healing. The advantages of tumor treatment by ion therapy are based on their special biological and physical features. Protons and carbons ion lead to an improved dose distribution compared to photons which allows an improved sparing of the neighboring risk organs and at the same time an escalation of the dose prescribed to the tumor. Carbon ions are furthermore superior to protons by biological advantages based on their enhanced biological effectivity. In general, heavy ions are considered as a good treatment option for tumors of low radiosensitivity as sarcomas. Superior survival and decreased toxicity rates are expected from the use of protons and carbon ions.

This randomized prospective open-label phase 2 trial testes the safety and feasibility of a hypofractionated accelerated neoadjuvant proton or carbon ion radiotherapy based on the rate of wound healing disorders from beginning of radiotherapy to maximum 120 days after the planned tumor resection or discontinuation of treatment due to any reason. The treatment is of shorter duration (2-3 weeks vs. 5 weeks standard treatment), which should please most patients and thus enhance quality of life. The treatment regimen furthermore promises a reduced rate of late side effects and significant optimization of the current treatment standards. A phase II trial is mandatory not only for obtaining the safety and feasibility data, but also in order to prepare a concurrent phase III trial. Due to the low incidence of soft tissue sarcoma, only a well prepared multicenter study has a chance to be successfully completed based on previous experiences in trials for seldom tumor entities.

Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 42 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Neoadjuvant Irradiation of Extremity Soft Tissue Sarcoma With Ions
Actual Study Start Date : June 21, 2021
Estimated Primary Completion Date : July 1, 2023
Estimated Study Completion Date : July 1, 2023

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Arm A: Protons, 39 Gy (RBE) in 13 fractions (single dose 3.0 Gy(RBE))
Arm A: Protons, 39 Gy (RBE) in 13 fractions (single dose 3.0 Gy(RBE))
 Radiation: Protons
proton irradiation with a total dose of 39 Gy(RBE) in 3 Gy(RBE) fractions
Experimental: Arm B: Carbon ions, 39 Gy(RBE) in 13 fractions (single dose 3.0 Gy(RBE))
Arm B: Carbon ions, 39 Gy(RBE) in 13 fractions (single dose 3.0 Gy(RBE))
 Radiation: carbon ions
carbon ion irradiation with a total dose of 39 Gy(RBE) in 3 Gy(RBE) fractions


Outcome Measures
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Primary Outcome Measures :
  1. Proportion of therapies without wound healing disorders and/or discontinuation [ Time Frame: from the beginning of radiotherapy (day1) until a maximum of 120 days after the resection ]
    Proportion of therapies without wound healing disorders and / or discontinuation in each study arm.


Secondary Outcome Measures :
  1. LC: Local control [ Time Frame: from start of radiotherapy to local onset to local tumor progression up to 5 years ]
    LC: Local control determined from local onset to local tumor progression

  2. LPFS: locally progression-free survival determined from onset of therapy to local tumor progression [ Time Frame: from start of radiotherapy to onset of therapy of local tumor progression up to 5 years ]
    LPFS: locally progression-free survival determined from onset of therapy to local tumor progression

  3. DFS: Disease-free survival [ Time Frame: from start of radiotherapy to onset of therapy until local and / or distant tumor progression up to 5 years ]
    DFS: Disease-free survival determined from onset of therapy until local and / or distant tumor progression

  4. OS: Overall survival [ Time Frame: from start of radiotherapy until death or censorship up to 5 years ]
    OS: Overall survival until death or censorship


Eligibility Criteria
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Information from the National Library of Medicine

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

Inclusion Criteria:

  • Histologically confirmed soft-tissue sarcoma of the extremities with an indication for perioperative radiation treatment
  • Resectable or marginally resectable
  • Karnofsky index of ≥ 70%
  • Age ≥ 18 years
  • Carried out patient education and written consent
  • Patient is capable to give informed consent

Exclusion Criteria:

  • Stage IV (distant metastases)
  • Lymph node metastasis
  • Metal implants that influence treatment planning with ions
  • Previous radiotherapy in the treatment area
  • Desmoid tumors
  • Simultaneous participation in another clinical trial that could influence the results of the study.
  • Active medical implants for which no ion beam irradiation permit exists at the time of treatment (e.g., cardiac pacemaker, defibrillator)
Contacts and Locations
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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): NCT04946357


Contacts
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Contact: Klaus Herfarth, Prof. Dr. 06221 56 34093 studienkoordination.RAD@med.uni-heidelberg.de

Locations
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Germany
University Hospital Heidelberg, Department of RadioOncology Recruiting
Heidelberg, Baden-Württemberg, Germany, 69120
Contact: Klaus Herfarth    062215634093    studienkoordination.RAD@med.uni-heidelberg.de   
Sponsors and Collaborators
University Hospital Heidelberg
More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: Juergen Debus, Prof. Dr. Dr., University Hospital Heidelberg
ClinicalTrials.gov Identifier: NCT04946357    
Other Study ID Numbers: EXTREM ION
First Posted: June 30, 2021    Key Record Dates
Last Update Posted: July 2, 2021
Last Verified: June 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Sarcoma
Neoplasms, Connective and Soft Tissue
Neoplasms by Histologic Type
Neoplasms