CPAP-RT: CPAP for Motion Management in Breast Radiotherapy; and Lung & Liver SABR

• Sponsor: Waikato Hospital (Other)
• Overall Status: Not yet recruiting
• CT.gov ID: NCT05396950
• Collaborator: (none)
• Enrollment: 70
• Arm: 1
• Anticipated Duration (Months): 12

Study Details

Study Description

Brief Summary

A phase II trial to determine the proportion of patients where the use of continuous positive airway pressure (CPAP) results in a superior radiation plan compared to standard planning procedures. The rationale for using CPAP with radiotherapy is based on its ability to increase the tidal volume, flatten the diaphragm thus reducing respiratory excursions.The resultant lung hyperinflation and reduced respiratory excursions can be harnessed for radiotherapy purposes by:

1. Displacing the heart away from the radiotherapy field

2. Reducing the volume of functional lung irradiated

3. Reducing the radiotherapy target motion

CPAP has been shown to be superior to free breathing radiotherapy (RT), however it remains unclear how much benefit it confers vs other motion management adjuncts such as deep inspiration breath hold (DIBH) or 4-DCT.

Condition or Disease	Intervention/Treatment	Phase
Cancer	Device: CPAP	N/A

Detailed Description

PRIMARY OBJECTIVE:

To determine the proportion of patients where the use of CPAP results in a superior radiation plan compared to standard planning procedures in each patient cohort

SECONDARY OBJECTIVES

To determine:

• Impact of CPAP on treatment delivery time;

• Impact of CPAP on total lung volume;

• CPAP compliance;

• Patient experience;

Breast-specific:

• Comparison of organ at risk (OAR) dose constraints between CPAP and deep DIBH)

SABR-specific:

• Internal target volume (ITV) reduction;

• OAR dose constraints between CPAP and standard planning procedures.

Breast cancer patients will undergo normal free breathing and DIBH radiotherapy planning scans. An additional scan with CPAP will be done for the purpose of the study. Radiotherapy plans will be produced on both the DIBH and CPAP planning scans. The planning scan with the best dosimetry will be chosen for treatment. If CPAP has a better radiation plan, then the patient will have CPAP administered during their daily RT. The DIBH plans for each patient, will serve as controls SABR patients will undergo the standard 4-D or breath hold CT and then CPAP CT for the purpose of the study. Respiratory movements will be monitored by Varian RPM system. Radiotherapy plans will be produced from the standard CT and the CPAP CT for comparison.

Patients will be treated on the best plan The trial aim to recruit 70 patients with invasive carcinoma of the breast undergoing adjuvant radiotherapy that includes breast/chest-wall plus regional lymph nodes, and a convenient sample size of those undergoing SABR to lung or liver

Study Design

• Study Type: Interventional
• Anticipated Enrollment: 70 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Intervention Model Description: Within subject comparisonWithin subject comparison
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Non Randomised Comparative Phase II Trial to Determine the Benefit of Continuous Positive Airway Pressure-assisted Radiotherapy vs Deep Inspiration Breath Hold in Breast Cancer and in Lung & Liver Stereotactic Ablative Body Radiotherapy
• Anticipated Study Start Date: Jul 1, 2022
• Anticipated Primary Completion Date: Jul 1, 2023
• Anticipated Study Completion Date: Jul 1, 2023

Arms and Interventions

Arm	Intervention/Treatment
Experimental: CPAP Planned Radiotherapy planning with CPAP in addition to standard plans	Device: CPAP; CPAP in conjunction with radiotherapy

Outcome Measures

Primary Outcome Measures

1. Radiotherapy Plan Selection [6-12 months]

   To determine the proportion of patients where the use of continuous positive airway pressure (CPAP) results in a superior radiation plan compared to standard planning procedures in each patient cohort

Secondary Outcome Measures

1. Organ at Risk Dose Constraints [6-12 months]

   Comparison of organ at risk dose constraints between CPAP assisted and standard RT plans Breast-specific: A comparison of OAR dose constraints in CPAP vs DIBH including: Mean Heart Dose, V20Gy heart Ipsilateral lung V16Gy and V5Gy SABR-Specific A comparison of OAR dose constraints in CPAP vs DIBH including: Lung V20Gy, Mean Lung Dose Heart V40Gy, Mean heart Dose Liver V15Gy, Mean liver Dose, Liver -GTV

2. Compliance and Tolerability [6-12 months]

   Assessment of compliance with CPAP as well as documentation of patient experiences • Patient experience as documented on a questionnaire after planning CT and on the last week of treatment

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• Any patient with pathologically-confirmed invasive breast cancer and planned for adjuvant radiotherapy to the breast or chest-wall with regional lymph node coverage

• Any patient deemed suitable for lung or liver SABR as per departmental guidelines

• Must have signed written informed consent

Exclusion Criteria:

• Cannot tolerate CPAP e.g due to severe claustrophobia

• Re-irradiation

Contacts and Locations

Locations

No locations specified.

Sponsors and Collaborators

• Waikato Hospital

Investigators

• Principal Investigator: Kenanao D Rantshilane, MBBS, Waikato Hospital

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Kenanao Rantshilane, Clinical and Research Fellow, Waikato Hospital
• ClinicalTrials.gov Identifier: NCT05396950
• Other Study ID Numbers: UTN: U1111-1278-1680
• First Posted: May 31, 2022
• Last Update Posted: Jun 2, 2022
• Last Verified: May 1, 2022

• Individual Participant Data (IPD) Sharing Statement: No
• Plan to Share IPD: No
• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Keywords provided by Kenanao Rantshilane, Clinical and Research Fellow, Waikato Hospital: SABR; CPAP; Breast; Lung; Liver

Study Results

No Results Posted as of Jun 2, 2022