CyberKnife Radiosurgical Treatment of Inoperable Early Stage Non-Small Cell Lung Cancer

NCT ID: NCT00643318

Last Updated: 2021-03-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-04-30

Study Completion Date

2021-12-31

Brief Summary

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The purpose of this study is to assess the short and long-term outcomes after CyberKnife stereotactic radiosurgery for early stage non-small cell lung cancer (NSCLC) in patients who are medically inoperable.

Detailed Description

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The objectives of this clinical evaluation are to assess the outcomes of patients who undergo stereotactic radiosurgery (SRS) to treat primary early stage non-small cell lung cancer (NSCLC) in patients (comprising of two cohorts, peripheral and central) who are not candidates for surgical resection because of high operative risks. In particular, the effect of CyberKnife SRS on clinical response rate, local control, progression-free survival, overall survival, dyspnea and QOL (for U.S. sites), and radiological findings over two years after treatment will be evaluated.

Conditions

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Non-small Cell Lung Cancer

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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CyberKnife Stereotactic Radiosurgery

Group Type EXPERIMENTAL

CyberKnife Stereotactic Radiosurgery

Intervention Type RADIATION

Central tumors defined as \< 2 cm from carina and \< 2 cm from right and left mainstem bronchus and/or \< 2 cms from the right and left upper lobe bronchus, bronchus intermedius, middle lobe bronchus, and the right and left lower lobe bronchus. For central tumors, 4 fractions of 12 Gy will be delivered (12 Gy x 4 fractions = 48 Gy)

Peripheral tumors are defined as being \> 2 cms from the carina and \> 2 cms from the right and left mainstem bronchus and/or \> 2 cms from the right and left upper lobe bronchus, bronchus intermedius, middle lobe bronchus and the right and left lower lobe bronchus. For peripheral tumors, 3 fractions of 20 Gy will be delivered (20 Gy x 3 fractions = 60 Gy)

Interventions

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CyberKnife Stereotactic Radiosurgery

Central tumors defined as \< 2 cm from carina and \< 2 cm from right and left mainstem bronchus and/or \< 2 cms from the right and left upper lobe bronchus, bronchus intermedius, middle lobe bronchus, and the right and left lower lobe bronchus. For central tumors, 4 fractions of 12 Gy will be delivered (12 Gy x 4 fractions = 48 Gy)

Peripheral tumors are defined as being \> 2 cms from the carina and \> 2 cms from the right and left mainstem bronchus and/or \> 2 cms from the right and left upper lobe bronchus, bronchus intermedius, middle lobe bronchus and the right and left lower lobe bronchus. For peripheral tumors, 3 fractions of 20 Gy will be delivered (20 Gy x 3 fractions = 60 Gy)

Intervention Type RADIATION

Other Intervention Names

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CyberKnife Stereotactic Radiosurgery Radiosurgery Radiation Therapy

Eligibility Criteria

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Inclusion Criteria

1. Patient must be over the age of 18 years
2. Pulmonary nodule with maximum diameter ≤ 5 cm
3. Histological confirmation of primary NSCLC
4. The following stage of NSCLC patients are eligible:

* Stage I: T1 N0 M0 or T2 N0 M0 (Tumor size ≤ 5 cm)
* Stage II: T3 N0 M0 (Chest wall invasion only, Tumor size ≤ 5 cm)
5. ECOG/Zubrod status of 0, 1 or 2
6. Thoracic surgery consultation should be obtained from a Board Certified Thoracic surgeon who in collaboration with a radiation oncologist should determine that the patient is not a surgical candidate.
7. In order to be considered medically inoperable, the patient must meet at least one major criteria or a minimum of 2 minor criteria as described below:

MAJOR CRITERIA:
1. FEV1 \< 50% or predicted postoperative FEV1 \< 40%
2. DLCO \< 50% or predicted postoperative DLCO \< 40%
3. Exercise induced maximal exercise oxygen consumption M VO2 \< 15 mL/kg/min
4. High-risk cardiac disease: Any one of the following:

* Poor left ventricular function (defined as an ejection fraction of \<=20%)
* Unstable coronary syndromes (unstable angina or severe angina Canadian class III or IV).
* Severe valvular disease (critical valvular stenosis),
* Recent myocardial infarction (\< 1 month),
* Significant arrhythmia defined by one of the following: High-grade AV block, Symptomatic ventricular arrhythmias in the presence of underlying heart disease, Supraventricular arrhythmias with uncontrolled ventricular rate

MINOR CRITERIA:
1. Age \> 75
2. Pulmonary hypertension (defined as a pulmonary artery systolic pressure greater than 40 mm Hg)
3. Oxygen requirement (using the Medicare criteria for home oxygen requirements \[i.e., room air oxygen saturation of 88% or less\])
4. Resting or exercise arterial pO2 ≤ 55 mm Hg OR SpO2 ≤ 88%.
5. pCO2 \> 45 mm Hg
6. Congestive heart failure (any three of the following must be documented: dyspnea, peripheral edema, chest x-ray with interstitial edema or cardiomegaly, rales, or congestion)
7. Moderately depressed left ventricular function (defined as an ejection fraction of 21-40% or less)
8. Severe cerebral (with CVA or recent TIA) or severe peripheral vascular disease
9. Diabetes Mellitus with severe organ damage such as ESRD, Blindness, Vascular disease.
10. Severe end organ damage from other causes resulting in ESRD, cirrhosis of the liver or vascular disease
11. FEV1 51%-60% or predicted postoperative FEV1 41-50%
12. DLCO 51-60% or predicted postoperative DLCO 41-50%
13. Modified Medical Research Council Dyspnea Scale ≥ grade 3
8. Females of child-bearing age must be using a reliable form of birth control.
9. The patient must have a PET-CT scan within 8 weeks of registration.
10. The patient must provide a signed and dated written informed consent PRIOR to registration and prior to undergoing any study-related procedures.
11. The patient must provide written authorization to allow the use and disclosure of their protected health information.

Exclusion Criteria

1. Excluding the primary cancer targeted for this treatment, the patient has a prior history of cancer (within the last 5 years) or concurrent cancer other than basal cell or squamous skin cancer.
2. Visible endobronchial lesion seen in the trachea, carina, major bronchus, lobar or segmental bronchus on bronchoscopy or microscopic disease detected in the trachea, carina, major bronchus, lobar or segmental bronchus.
3. The patient's weight exceeds the tolerances of the institution's imaging and CyberKnife platform/couch.
4. The patient has received thoracic radiation therapy in the same field as the planned treatment area in the past.
5. The patient has completed chemotherapy within less than 30 days of treatment.
6. T2: Tumor size \> 5 cm, T3 tumors (except T3 by virtue of chest wall invasion and ≤ 5 cm), T4 tumors. Presence of N1, N2 or N3 disease per previously described criteria would be excluded.
7. Pancoast tumors would be excluded.
8. Current distant metastatic disease (M1) (preferably biopsy proven).
9. The patient is a female with child-bearing potential who refuses to take a pregnancy test prior to treatment.
10. The patient is pregnant or a female who is nursing an infant.
11. The patient is planning on undergoing systemic therapy within 2 weeks after the last fraction of radiation
12. The patient has an active systemic or pulmonary infection.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Pittsburgh

OTHER

Sponsor Role collaborator

Accuray Incorporated

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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James Luketich, MD

Role: STUDY_CHAIR

University of Pittsburgh Medical Center

Locations

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St Joseph's Hospital/Barrow Neurological Institute

Phoenix, Arizona, United States

Site Status

Community Regional Medical Center

Fresno, California, United States

Site Status

Stanford University

Palo Alto, California, United States

Site Status

Penrose Cancer Center

Colorado Springs, Colorado, United States

Site Status

Denver CyberKnife

Lone Tree, Colorado, United States

Site Status

North Florida Radiation Oncology

Gainesville, Florida, United States

Site Status

Naples Community Hospital

Naples, Florida, United States

Site Status

Northwest Community Hospital

Arlington Heights, Illinois, United States

Site Status

Advocate Christ Med Center

Oak Lawn, Illinois, United States

Site Status

Parkview Cancer Center

Fort Wayne, Indiana, United States

Site Status

St. Catherine's Hospital

Munster, Indiana, United States

Site Status

Central Baptist Hospital

Lexington, Kentucky, United States

Site Status

Sinai Hospital of Baltimore

Baltimore, Maryland, United States

Site Status

St. Louis University Hospital

St Louis, Missouri, United States

Site Status

St. Mary's Regional Medical Center

Reno, Nevada, United States

Site Status

St. Anthony's Hospital

Oklahoma City, Oklahoma, United States

Site Status

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Site Status

Baylor Research Institute

Dallas, Texas, United States

Site Status

St. Luke's Episcopal Hospital

Houston, Texas, United States

Site Status

Multicare Health System

Tacoma, Washington, United States

Site Status

Aurora St. Luke's Medical Center

Milwaukee, Wisconsin, United States

Site Status

Ruikang Hospital

Nanning, Guangxi, China

Site Status

Tianjin Medical University Cancer Institution and Hospital

Tianjin, , China

Site Status

Countries

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United States China

Related Links

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http://www.accuray.com

Accuray Website

Other Identifiers

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ACCL001.0

Identifier Type: -

Identifier Source: org_study_id

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