NSCLCNCT02029222
Photon Versus Particle Therapy for Recurrent Lung Cancer; a Planning Study Based on a Reference Dataset of Patients.
An observational study of NSCLC, run by Maastricht Radiation Oncology at 1 site in Netherlands.
Trial summary
Patients with lung cancer may develop a second primary tumor or recurrent disease after previous radiotherapy. Surgical salvage therapy is the mainstay of therapeutic options. However, in case of irresectable disease, re-irradiation should be considered. Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- NSCLC
- How many people
- 25 participants
- Where
- 1 siteNetherlands
- Study dates
- Dec 2013to Sep 2019
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Study population: 25 patients with SCLC
Who may be able to join
- Re-irradiation patients for relapsed or second cancers in the left or the right lung
- Received respitory gated CT (4DCT) and PET (4DPET) scans.
- The primary treatment was radiotherapy with a curative intent
- The organs at risk of the primary tumor treatment are the same organs at risk at the secondary treatment
- 18 years or older
Who cannot join
None listed.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: In Silico Clinical Trial on Re-irradiation Lung Cancer, Comparing Photon, Proton and 12C-ion Therapy: A Multicentric ROCOCO Planning Study Based on a Reference Dataset of Patients.
Patients with lung cancer may develop a second primary tumor or recurrent disease after previous radiotherapy. Surgical salvage therapy is the mainstay of therapeutic options. However, in case of irresectable disease, re-irradiation should be considered. Also in the postoperative setting, re-irradiation is considered after surgical salvage in case of features in the pathology specimen indicating a high risk for subsequent recurrence. However after re-irradiation, there is a high risk of 43% grade 3 (late) toxicity at 5 years (including possible fatal complications) and a relatively low chance of locoregional control of 50% at 5 years. One out of three patients survives re-irradiation without recurrence and severe complications. Improvements in both the risk of radiation-induced complications and the oncological outcome are thus warranted.
Compared to conventional radiotherapy with photons (CRT), particle therapy (PT) has the potential to inflict maximum damage on tumors with minimum collateral damage to neighboring healthy tissue. Given that the cost of particle therapy (PT) is considerably higher than that of conventional radiotherapy (RT) with photons, it is necessary to establish whether these higher costs are worthwhile in light of the expected advantages. Thus, clear evidence of the situations in which PT outperforms conventional photon treatment is needed. Publications on this topic are rare. The only recent publication has analyzed the results of 37 NSCLC patients of whom 9 were re-irradiated with at least 50 Gy using helical tomotherapy [Kruser in press].
We propose an in silico trial to investigate to what extend proton and 12C-ion therapy decrease the amount of irradiated normal tissue in lung cancer patients treated with radiotherapy after an initial radiotherapy treatment.
Read the detailed description
For this in silico planning study all treatment plans will be performed in centers that are already operating and have experience in treatment planning. Photon treatment plans will be carried out in Maastricht, proton treatment plans at the University of Pennsylvania and the C-ion treatment plans at the University of Wisconsin.
A dataset with state-of-the-art image data is available. 25 patients will be included according to a-priori defined selection criteria. Each patient will function as his or her own control. For this reason, the number of patients per tumor group can be limited to 25 patients per tumor group (power = 80%, alpha = 5%).
The datasets will be stored on a secure website hosted by MAASTRO. High quality CT-images will be used for radiotherapy treatment planning. If available, secondary image information such as FDG-PET and MRI will be used for GTV delineation. All relevant OARs will be delineated in both the primary and secondary studyset. GTV/CTV will be used accordingly to the actual treatment. New DVH's will be calculated for the added OAR. Dose restrictions for the re-irradiation plan will be defined for each individual patient based on the DVH dose in the primary photon treatment plan.
Photons will be planned with direct Aperture Optimized Intensity Modulated Radiotherapy (IMRT). Protons will be planned using active beam delivery with Intensity Modulated proton therapy (IMPT)and carbon-ions with a pencil beam delivery treatment planning technique with gantry. Each participating center will use its own treatment planning system according to standard practice at that center. The GTV to PTV margin will be determined by the individual institutes according to the treatment technique and treatment modality. The same tumor dose, overall treatment time (OTT) and an equal number of fractions will be used for all treatment modalities.
Photon, proton and C-ion treatments will be compared based on dosimetric parameters on normal tissues. In addition, the NTCP for a fixed tumor dose or the same expected TCP will be determined. Cobalt Gy equivalent doses will be used when reporting the proton and carbon-ion dose. In the case of protons, a constant RBE value of 1.1 will be used for both the tumor and the normal tissues. The RBE of carbon-ions will be calculated based on the models used by the participating centers.
Dose in the following structures will be taken into account:
- Lungs
- Spinal court
- Heart
- Oesophagus
- Conditions
- NSCLC
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| 25 NSCLC patients | 25 NSCLC patients who received curative radiotherapy. Re-irradiation can either be indicated for primary or secondary cancers in the lung. All patients referred for primary radiotherapy or chemoradiation after curative radiation therapy more or equal to one year ago with overlapping CTV will be included. The organs at risk of the primary tumor are the same organs at risk at the secondary treatment. |
What is being measured
The primary outcome is the main question the study is designed to answer.
The amount of irradiated normal tissue: lung
- lung: V30, V20, V13, V5, mean lung dose
Measured: Up to ten months (planning time)
The amount of irradiated normal tissue: Spinal cord
Spinal cord: Dmax
Measured: Up to ten months
The amount of irradiated normal tissue: esophagus
Esophagus: Dmax, mean dose (MD), V55, V35
Measured: Up to ten months
The amount of irradiated normal tissue: Heart
Heart: Total dose (TD), V65, V45, V40, V30, V20, V10, MD
Measured: Up to ten months
The amount of irradiated normal tissue: Integral dose
Integral dose
Measured: Up to ten months
Secondary outcomes (1)
Risk of side effects in the irradiated normal tissue
Measured: Up to ten months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Jan 2014 (estimated)
- Study startDec 2013
- Primary completionSep 2019
- Study completionSep 2019
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for NSCLCStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Retrospective
- Enrolment
- 25 participants (actual)
Sponsor and investigators
- Lead sponsor
- Maastricht Radiation Oncology
- Sponsor type
- University, hospital or other
- Collaborators
- University of Pennsylvania, University of Wisconsin, Madison
- Responsible party
- Sponsor
- Investigators
- Philippe Lambin, MD, PhD, Principal investigator, Maastro Clinic, The Netherlands
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02029222
- Sponsor's protocol ID
- ROCOCO
- Status last verified
- Sep 2019
- First submitted
- 19 Dec 2013
- Last updated
- 4 Sep 2019
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 4 Sep 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- In Silico Clinical Trial on Re-irradiation Lung Cancer, Comparing Photon, Proton and 12C-ion Therapy: A Multicentric ROCOCO Planning Study Based on a Reference Dataset of Patients.
- ClinicalTrials.gov ID
- NCT02029222
- Acronym / sponsor ID
- ROCOCO
- Conditions
- NSCLC
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 25 participants (actual)
- Lead sponsor
- Maastricht Radiation OncologyUniversity, hospital or other
- Collaborators
- University of Pennsylvania, University of Wisconsin, Madison
- Study start
- Dec 2013 (actual)
- Primary completion
- Sep 2019 (actual)
- Study completion
- Sep 2019 (actual)
- First posted
- 7 Jan 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Patients with lung cancer may develop a second primary tumor or recurrent disease after previous radiotherapy. Surgical salvage therapy is the mainstay of therapeutic options. However, in case of irresectable disease, re-irradiation should be considered. Also in the postoperative setting, re-irradiation is considered after surgical salvage in case of features in the pathology specimen indicating a high risk for subsequent recurrence. However after re-irradiation, there is a high risk of 43% grade 3 (late) toxicity at 5 years (including possible fatal complications) and a relatively low chance of locoregional control of 50% at 5 years. One out of three patients survives re-irradiation without recurrence and severe complications. Improvements in both the risk of radiation-induced complications and the oncological outcome are thus warranted.
Compared to conventional radiotherapy with photons (CRT), particle therapy (PT) has the potential to inflict maximum damage on tumors with minimum collateral damage to neighboring healthy tissue. Given that the cost of particle therapy (PT) is considerably higher than that of conventional radiotherapy (RT) with photons, it is necessary to establish whether these higher costs are worthwhile in light of the expected advantages. Thus, clear evidence of the situations in which PT outperforms conventional photon treatment is needed. Publications on this topic are rare. The only recent publication has analyzed the results of 37 NSCLC patients of whom 9 were re-irradiated with at least 50 Gy using helical tomotherapy [Kruser in press].
We propose an in silico trial to investigate to what extend proton and 12C-ion therapy decrease the amount of irradiated normal tissue in lung cancer patients treated with radiotherapy after an initial radiotherapy treatment.
Detailed description
For this in silico planning study all treatment plans will be performed in centers that are already operating and have experience in treatment planning. Photon treatment plans will be carried out in Maastricht, proton treatment plans at the University of Pennsylvania and the C-ion treatment plans at the University of Wisconsin.
A dataset with state-of-the-art image data is available. 25 patients will be included according to a-priori defined selection criteria. Each patient will function as his or her own control. For this reason, the number of patients per tumor group can be limited to 25 patients per tumor group (power = 80%, alpha = 5%).
The datasets will be stored on a secure website hosted by MAASTRO. High quality CT-images will be used for radiotherapy treatment planning. If available, secondary image information such as FDG-PET and MRI will be used for GTV delineation. All relevant OARs will be delineated in both the primary and secondary studyset. GTV/CTV will be used accordingly to the actual treatment. New DVH's will be calculated for the added OAR. Dose restrictions for the re-irradiation plan will be defined for each individual patient based on the DVH dose in the primary photon treatment plan.
Photons will be planned with direct Aperture Optimized Intensity Modulated Radiotherapy (IMRT). Protons will be planned using active beam delivery with Intensity Modulated proton therapy (IMPT)and carbon-ions with a pencil beam delivery treatment planning technique with gantry. Each participating center will use its own treatment planning system according to standard practice at that center. The GTV to PTV margin will be determined by the individual institutes according to the treatment technique and treatment modality. The same tumor dose, overall treatment time (OTT) and an equal number of fractions will be used for all treatment modalities.
Photon, proton and C-ion treatments will be compared based on dosimetric parameters on normal tissues. In addition, the NTCP for a fixed tumor dose or the same expected TCP will be determined. Cobalt Gy equivalent doses will be used when reporting the proton and carbon-ion dose. In the case of protons, a constant RBE value of 1.1 will be used for both the tumor and the normal tissues. The RBE of carbon-ions will be calculated based on the models used by the participating centers.
Dose in the following structures will be taken into account:
- Lungs
- Spinal court
- Heart
- Oesophagus
Study design
- Observational model
- Cohort
- Time perspective
- Retrospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| 25 NSCLC patients | – | –25 NSCLC patients who received curative radiotherapy. Re-irradiation can either be indicated for primary or secondary cancers in the lung. All patients referred for primary radiotherapy or chemoradiation after curative radiation therapy more or equal to one year ago with overlapping CTV will be included. The organs at risk of the primary tumor are the same organs at risk at the secondary treatment. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
- Study population
- 25 patients with SCLC
Key inclusion criteria (5 listed)
- Re-irradiation patients for relapsed or second cancers in the left or the right lung
- Received respitory gated CT (4DCT) and PET (4DPET) scans.
- The primary treatment was radiotherapy with a curative intent
- The organs at risk of the primary tumor treatment are the same organs at risk at the secondary treatment
- 18 years or older
Key exclusion criteria (0 listed)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
The amount of irradiated normal tissue: lung
Time frame: Up to ten months (planning time)
- lung: V30, V20, V13, V5, mean lung dose
The amount of irradiated normal tissue: Spinal cord
Time frame: Up to ten months
Spinal cord: Dmax
The amount of irradiated normal tissue: esophagus
Time frame: Up to ten months
Esophagus: Dmax, mean dose (MD), V55, V35
The amount of irradiated normal tissue: Heart
Time frame: Up to ten months
Heart: Total dose (TD), V65, V45, V40, V30, V20, V10, MD
The amount of irradiated normal tissue: Integral dose
Time frame: Up to ten months
Integral dose
1 secondary outcome
Risk of side effects in the irradiated normal tissue
Time frame: Up to ten months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Sep 2019.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Philippe Lambin, MD, PhD principal investigator
Maastro Clinic, The Netherlands
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of NSCLC, run by Maastricht Radiation Oncology at 1 site in Netherlands.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 0 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 Sep 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The amount of irradiated normal tissue: lung (time frame: Up to ten months (planning time)). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Sep 2019.