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Stereotactic Body Radiation Therapy With Boost Using Urethral-Sparing Intensity-Modulated Radiation Therapy Planning in Treating Patients With Prostate Cancer

Sponsor
University of Wisconsin, Madison (Other)
Overall Status
Recruiting
CT.gov ID
NCT02470897
Collaborator
(none)
160
Enrollment
3
Locations
2
Arms
136.3
Anticipated Duration (Months)
53.3
Patients Per Site
0.4
Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This phase I/II trial studies the side effects and best dose of stereotactic body radiation therapy while using intensity-modulated radiation therapy (IMRT) planning to help avoid radiation to normal tissue in patients with prostate cancer. Stereotactic body radiation therapy is a specialized radiation therapy that sends x-rays directly to the tumor using small, high doses of radiation over several days and may cause less damage to normal tissue. This treatment schedule allows for a higher dose of radiation to be administered over a shorter overall treatment period in comparison to standard radiation therapy.

Condition or Disease Intervention/Treatment Phase
  • Radiation: Radiation Therapy Treatment Planning and Simulation
  • Radiation: SBRT
  • Radiation: SBRT
 N/A

Detailed Description

PRIMARY OBJECTIVES:

  1. To evaluate the incidence of genitourinary (GU) and gastrointestinal (GI) acute and late toxicity for patients treated with prostate stereotactic body radiotherapy (SBRT) with simultaneous integrative boost, urethral ring sparing, and enhanced prostate localization (magnetic resonance imaging [MRI-computed tomography [CT] fusion).

  2. To also evaluate the incidence of GU and GI acute and late toxicity for patients treated with prostate stereotactic body radiotherapy (SBRT) with a more conventional and uniformly delivered dose of 7.25 Gy/fraction to the prostate.

  3. Disease-free survival: disease-free failure events include local progression, distant progression, biochemical failure as defined by the Radiation Therapy Oncology Group (RTOG) Phoenix definition, and death from any cause.

SECONDARY OBJECTIVES:
  1. Evaluate patient quality of life (QOL) using the Expanded Prostate Cancer Index Composite 26 (EPIC-26) for evaluation of the QOL for up to 3 years after the completion of SBRT.

OUTLINE: Participants are assigned to 1 of 2 treatment arms. Participants unable to undergo MRI, whose MRI proves technically inadequate for delineating needed anatomic structures, or who decline to enroll on Arm A are assigned to Arm B.

ARM A: (n = 120) Participants undergo 5 fractions of moderate dose SBRT with simultaneous integrated boost (SIB) every other day for 10 days following urethral-sparing IMRT planning.

ARM B: (n = 40) Participants undergo 5 fractions of uniform dose SBRT every other day for 10 days following undergo urethral-sparing IMRT planning.

After completion of study treatment, patients are followed up at 4-8 weeks, at 4, 8, and 12 months, every 4 months for 1 year, every 6 months for 3 years, and then every 12 months thereafter.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
160 participants
Allocation:
Non-Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
A Phase I/II Study of Stereotactic Body Radiotherapy (SBRT) for Prostate Cancer Using Simultaneous Integrated Boost and Urethral-Sparing IMRT Planning
Actual Study Start Date :
Jul 24, 2015
Anticipated Primary Completion Date :
Dec 1, 2026
Anticipated Study Completion Date :
Dec 1, 2026

Arms and Interventions

Arm Intervention/Treatment
Experimental: Arm A (moderate dose SBRT with SIB)

Patients undergo 5 fractions of moderate dose SBRT with SIB every other day for 10 days following urethral-sparing IMRT planning. SBRT: 8.0Gy escalated dose

Radiation: Radiation Therapy Treatment Planning and Simulation
Undergo urethral-sparing IMRT planning
Other Names:
  • Radiation Therapy Treatment Planning/Simulation

    • Radiation: SBRT
    Undergo moderate dose SBRT with SIB
    Other Names:
  • Stereotactic Body Radiation Therapy

    		•
    Active Comparator: Arm B (uniform dose SBRT)

    Patients undergo 5 fractions of uniform dose SBRT every other day for 10 days following urethral-sparing IMRT planning. SBRT: 7.5Gy conventional dose

    Radiation: Radiation Therapy Treatment Planning and Simulation
    Undergo urethral-sparing IMRT planning
    Other Names:
  • Radiation Therapy Treatment Planning/Simulation

    • Radiation: SBRT
    Undergo uniform dose SBRT
    Other Names:
  • Stereotactic Body Radiation Therapy

    		•

    Outcome Measures

    Primary Outcome Measures

    1. Incidence of GU and GI Acute Toxicity [Up to 90 days]

      Evaluation of delivering SBRT to the prostate using non-uniform dosing. The investigators will evaluate the potential for any added grade 3 rectal toxicity with the use of a simultaneous integrated boost.

    2. Incidence of GU and GI Late Toxicity [Up to 60 months]

      Evaluation of delivering SBRT to the prostate using non-uniform dosing. The investigators will evaluate the potential for any added grade 3 rectal toxicity with the use of a simultaneous integrated boost. A late adverse event will be defined as an adverse event occurring more than 90 days from the completion of RT.

    3. Disease-free survival as measured by the Phoenix definition [Up to 60 months]

    Secondary Outcome Measures

    1. Change in Expanded Prostate Cancer Index Composite (EPIC) 26 Quality of Life Assessment [at Baseline, 1 year, and 2 years]

      The EPIC 26 assessment has a total range of possible scores of 1-100 where higher scores indicate higher satisfaction. Questionnaires will be performed prior to treatment, and one and two years after completion of treatment.

    2. Change in American Urological Association Symptom Score (AUASS) [at Baseline, 1 year, and 2 years]

      The AUASS has a total possible range of scores of 0-35 where 1-7 is considered mild symptoms, 8-19 is considered moderate symptoms, and 20-35 is considered severe symptoms. Questionnaires will be performed prior to treatment, and one and two years after completion of treatment.

    3. Change in International Index of Erectile Dysfunction Questionnaire (IIEF-5) [at Baseline, 1 year, and 2 years]

      The IIEF-5 questionnaire has a total score of 1-25 where 1-7 is considered severe erectile dysfunction (ED), 8-11 is moderate ED, 12-16 is mild-moderate ED, 17-21 is mild ED, and 22-25 is no ED. Questionnaires will be performed prior to treatment, and one and two years after completion of treatment.

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    N/A and Older
    Sexes Eligible for Study:
    Male
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:

    • Histologically confirmed diagnosis of adenocarcinoma of the prostate and most recent biopsy within 180 days of study enrollment

    • History/physical examination with digital rectal examination of the prostate within 90 days prior to study enrollment

    • Gleason score =< 7, no tertiary pattern >= 5

    • Clinical stage =< T2b (American Joint Committee on Cancer [AJCC] 7th Edition Staging Manual) and no radiographic evidence of T3 or T4 disease

    • Clinical stage N0, M0

    • Most recent prostate specific antigen (PSA) within 60 days of enrollment

    • Maximum PSA =< 20 ng/ml (not within 20 days after biopsy)

    • Eastern Cooperative Oncology Group (ECOG) performance status 0-1

    • American Urological Association (AUA) =< 18 with or without medical management

    • Up to a total of year of androgen deprivation allowed.

    • Participant signs study specific informed consent prior to study enrollment

    Exclusion Criteria:

    • FOR ARM A: Inability to obtain a planning MRI or a planning MRI of sufficient quality to allow identification of the peripheral zone and urethra, or inability to adequately fuse the MRI to the planning CT scan

    • FOR BOTH ARM A AND ARM B:

    • Prior or concurrent invasive malignancy (except non-melanomatous skin cancer) or lymphomatous/hematogenous malignancy unless continually disease free for a minimum of 5 years; (for example, carcinoma in situ of the bladder or oral cavity is permissible)

    • Prosthetic implants in the pelvic region that the investigator feels will impede treatment, planning, or delivery (e.g., an artificial hip)

    • =< 3 months from a transurethral resection of the prostate (TURP) procedure

    • Significant urinary obstruction (i.e. AUA symptom score > 18)

    • Previous pelvic irradiation, prostate brachytherapy

    • Previous radical surgery (prostatectomy) or cryosurgery for prostate cancer

    • Severe, active comorbidity, defined as follows:

    • Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration

    • Crohn's disease or ulcerative colitis

    • Scleroderma

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Swedish American Rockford Illinois United States 61104
    2 UW Cancer Center, Johnson Creek Johnson Creek Wisconsin United States 53038
    3 University of Wisconsin Carbone Cancer Center Madison Wisconsin United States 53792

    Sponsors and Collaborators

    • University of Wisconsin, Madison

    Investigators

    • Principal Investigator: Zachary Morris, University of Wisconsin, Madison

    Study Documents (Full-Text)

    None provided.

    More Information

    Additional Information:

    Publications

    None provided.
    Responsible Party:
    University of Wisconsin, Madison
    ClinicalTrials.gov Identifier:
    NCT02470897
    Other Study ID Numbers:
    • UW14083
    • NCI-2015-00950
    • 2015-0395
    • UW14083
    • A533300
    • SMPH\HUMAN ONCOLOGY\HUMAN ONCO
    • Protocol Version 1/29/2021
    First Posted:
    Jun 12, 2015
    Last Update Posted:
    Mar 8, 2022
    Last Verified:
    Mar 1, 2022
    Studies a U.S. FDA-regulated Drug Product:
    No
    Studies a U.S. FDA-regulated Device Product:
    Yes
    Additional relevant MeSH terms:
    Prostatic Neoplasms
    Adenocarcinoma

    Study Results

    No Results Posted as of Mar 8, 2022