Study of Tumour Focused Radiotherapy for Bladder Cancer

NCT ID: NCT02447549

Last Updated: 2020-06-09

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

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE2

Total Enrollment

345 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-10-21

Study Completion Date

2029-03-31

Brief Summary

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Bladder cancer is the seventh most common cancer in the UK, with 10,399 new cases diagnosed in 2011. In a quarter of these cases the cancer has infiltrated the muscular wall of the bladder (muscle invasive) and is life threatening. This type of bladder cancer is usually treated either with surgical removal of the bladder, or daily radiotherapy treatment (high strength xrays which kill cells), given every day for 4 or 7 weeks. RAIDER will investigate methods which have the potential to improve how well this radiotherapy works.

RAIDER is based on a study of novel radiotherapy techniques which was conducted at a single UK NHS Trust. Bladder radiotherapy is normally delivered using a single plan throughout treatment and treats the whole bladder with the same radiotherapy dose. In adaptive radiotherapy the delivery plan is chosen from 3 possible plans. In cancer (tumour) focused radiotherapy, the highest dose of the radiotherapy is aimed at the tumour within the bladder.

In RAIDER, at least 240 participants with muscle invasive bladder cancer will be in one of 3 treatment groups:

1. standard whole bladder radiotherapy
2. standard dose tumour focused adaptive radiotherapy
3. dose escalated tumour boost adaptive radiotherapy

Participants will visit the hospital 4 weeks, 3, 6, 9, 12, 18 and 24 months after radiotherapy and annually thereafter to check whether the cancer has returned and to receive treatment for any symptoms they may be experiencing.

RAIDER aims to confirm in a multicentre setting that novel techniques allow a higher radiotherapy dose than standard to be reliably targeted at the tumour within the bladder and to check that the long term side effects of the treatment are acceptable. If this is the case, results of RAIDER will be used to develop a study to establish whether dose escalated radiotherapy is better at treating bladder cancer than standard dose.

Detailed Description

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RAIDER has a two stage design. Stage 1 will establish the feasibility of delivering DART in a multi-centre setting, and stage 2 will establish the toxicity of DART. 72 patients will be recruited in stage 1, with at least an additional 168 patients in stage 2 (sufficient to recruit 57 evaluable participants to the DART group in each fractionation cohort).

Both fractionation regimens in standard use in UK are included - 32f and 20f. Participants will be permitted to receive concomitant chemotherapy. Primary endpoints will be assessed in each fractionation cohort separately with the flexibility to drop either a fractionation cohort or an experimental treatment group (on advice of Independent Data Monitoring Committee) following completion of stage 1.

Conditions

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Bladder Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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WBRT

Standard dose whole bladder radiotherapy

Group Type ACTIVE_COMPARATOR

WBRT

Intervention Type RADIATION

One RT plan with whole bladder treated to standard dose.

SART

Standard dose Adaptive tumour focused radiotherapy (SART)

Group Type EXPERIMENTAL

SART

Intervention Type RADIATION

Three plans (small, medium \& large) generated with the standard dose of RT focused on the tumour, sparing the normal bladder from full dose radiation. Pretreatment cone beam CTs will be used to select the best fitting of the three plans prior to treatment.

DART

Dose escalated Adaptive tumour boost radiotherapy (DART)

Group Type EXPERIMENTAL

DART

Intervention Type RADIATION

Three plans (small, medium \& large) generated with a higher dose than standard focused on the tumour and the remainder of the bladder treated to the same dose as in the SART group. Pretreatment cone beam CTs will be used to select the best fitting of the three plans prior to treatment.

Interventions

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WBRT

One RT plan with whole bladder treated to standard dose.

Intervention Type RADIATION

SART

Three plans (small, medium \& large) generated with the standard dose of RT focused on the tumour, sparing the normal bladder from full dose radiation. Pretreatment cone beam CTs will be used to select the best fitting of the three plans prior to treatment.

Intervention Type RADIATION

DART

Three plans (small, medium \& large) generated with a higher dose than standard focused on the tumour and the remainder of the bladder treated to the same dose as in the SART group. Pretreatment cone beam CTs will be used to select the best fitting of the three plans prior to treatment.

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

* Written informed consent
* Age ≥16 years
* Histologically or cytologically confirmed transitional cell carcinoma (TCC) of the bladder
* Unifocal bladder TCC staged T2-T4a N0 M0\*
* Fit to receive a radical course of radiotherapy
* WHO performance status 0-2
* Willing and able to comply with study procedures and follow up schedule \*Tumour location must be clearly visible on imagine or recorded on a surgical bladder map

Exclusion Criteria

* Nodal or metastatic disease
* Multifocal invasive disease
* Simultaneous TCC in upper tract or urethra
* Pregnancy
* Active malignancy within 2 years of randomisation (not including non melanomatous skin carcinoma, previous non muscle invasive bladder tumours, NCCN low risk prostate cancer (T1/T2a, Gleason 6 PSA \<10), in situ carcinoma of any site)
* Bilateral hip replacements
* Any other conditions that in the Principal Investigator's opinion would be a contra-indication to radiotherapy (e.g. previous pelvic radiotherapy / inflammatory bowel disease)
Minimum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Trans Tasman Radiation Oncology Group

OTHER

Sponsor Role collaborator

Institute of Cancer Research, United Kingdom

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Robert Huddart

Role: PRINCIPAL_INVESTIGATOR

Institute of Cancer Research/RMNHSFT

Locations

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Riverina Cancer Care Centre

Wagga Wagga, New South Wales, Australia

Site Status

Princess Alexandra Hospital

Brisbane, Queensland, Australia

Site Status

Townsville General Hospital

Douglas, Queensland, Australia

Site Status

Radiation Oncology Mater Centre QLD

South Brisbane, Queensland, Australia

Site Status

Royal Hobart Hospital

Hobart, Tasmania, Australia

Site Status

Austin Hospital

Melbourne, Victoria, Australia

Site Status

Sir Charles Gairdner Hospital

Nedlands, Western Australia, Australia

Site Status

Auckland Hospital

Auckland, , New Zealand

Site Status

Christchurch Hospital

Christchurch, , New Zealand

Site Status

Waikato

Hamilton, , New Zealand

Site Status

Torbay District General Hospital

Torquay, Devon, United Kingdom

Site Status

Barts Health NHS Trust

London, England, United Kingdom

Site Status

The Christie NHS Foundation Trust

Manchester, England, United Kingdom

Site Status

Nottingham University Hospital NHS Trust

Nottingham, England, United Kingdom

Site Status

Queen's Hospital, Barking Havering and Redbridge University Hospitals NHS Trust

Romford, Essex, United Kingdom

Site Status

Mount Vernon Cancer Centre

Northwood, Middlesex, United Kingdom

Site Status

Ayr Hospital

Ayr, Scotland, United Kingdom

Site Status

Maidstone Hospital, Kent Oncology Centre

Adstone, , United Kingdom

Site Status

Belfast City Hospital

Belfast, , United Kingdom

Site Status

Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust

Birmingham, , United Kingdom

Site Status

Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust

Birmingham, , United Kingdom

Site Status

Bradford Teaching Hospitals NHS Foundation Trust

Bradford, , United Kingdom

Site Status

Royal Sussex County Hospital

Brighton, , United Kingdom

Site Status

Bristol Haematology & Oncology Centre

Brixton, , United Kingdom

Site Status

West Suffolk Hospital

Bury St Edmunds, , United Kingdom

Site Status

Addenbrooke's Hospital

Cambridge, , United Kingdom

Site Status

Velindre Hospital, Cardiff and Vale NHS Trust

Cardiff, , United Kingdom

Site Status

Cheltenham General Hospital

Cheltenham, , United Kingdom

Site Status

University Hospital Coventry

Coventry, , United Kingdom

Site Status

Western General Hospital

Edinburgh, , United Kingdom

Site Status

Royal Devon and Exeter Hospital

Exeter, , United Kingdom

Site Status

Beatson West of Scotland Cancer Centre

Glasgow, , United Kingdom

Site Status

St Luke's Cancer Centre

Guildford, , United Kingdom

Site Status

Leeds Teaching Hospitals NHS Trust

Leeds, , United Kingdom

Site Status

Guy's and St Thomas' Hospital

London, , United Kingdom

Site Status

Royal Marsden NHSFT

London, , United Kingdom

Site Status

Royal Oldham Hospital

Manchester, , United Kingdom

Site Status

The Clatterbridge Cancer Centre NHS Foundation Trust

Metropolitan Borough of Wirral, , United Kingdom

Site Status

Northern Centre for Cancer Care, Freeman Hospital,

Newcastle upon Tyne, , United Kingdom

Site Status

Norfolk and Norwich University Hospital

Norwich, , United Kingdom

Site Status

The Royal Oldham Hospital

Oldham, , United Kingdom

Site Status

Peterborough City Hospital

Peterborough, , United Kingdom

Site Status

Queen Alexandra Hospital

Portsmouth, , United Kingdom

Site Status

Royal Preston Hospital

Preston, , United Kingdom

Site Status

Weston Park Hospital, Sheffield Teaching Hospitals Trust

Sheffield, , United Kingdom

Site Status

Kings Mill Hospital, Sherwood Forest Hospitals Foundation NHS Trust

Sutton in Ashfield, , United Kingdom

Site Status

Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust

Taunton, , United Kingdom

Site Status

Mid Yorkshire Hospitals

Wakefield, , United Kingdom

Site Status

Pinderfields hospital, The Mid Yorkshire Hospitals NHS Trust

Wakefield, , United Kingdom

Site Status

Countries

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Australia New Zealand United Kingdom

References

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Hafeez S, Warren-Oseni K, Jones K, Mohammed K, El-Ghzal A, Dearnaley D, Harris V, Khan A, Kumar P, Lalondrelle S, McDonald F, Tan M, Thomas K, Thompson A, McNair HA, Hansen VN, Huddart RA. Bladder Tumor-Focused Adaptive Radiation Therapy: Clinical Outcomes of a Phase I Dose Escalation Study. Int J Radiat Oncol Biol Phys. 2025 Jan 1;121(1):165-175. doi: 10.1016/j.ijrobp.2024.07.2317. Epub 2024 Jul 26.

Reference Type DERIVED
PMID: 39069239 (View on PubMed)

Huddart R, Hafeez S, Omar A, Alonzi R, Birtle A, Cheung KC, Choudhury A, Foroudi F, Gribble H, Henry A, Hilman S, Hindson B, Lewis R, Muthukumar D, McLaren DB, McNair H, Nikapota A, Olorunfemi A, Parikh O, Philipps L, Rimmer Y, Syndikus I, Tolentino A, Varughese M, Vassallo-Bonner C, Webster A, Griffin C, Hall E. Acute Toxicity of Hypofractionated and Conventionally Fractionated (Chemo)Radiotherapy Regimens for Bladder Cancer: An Exploratory Analysis from the RAIDER Trial. Clin Oncol (R Coll Radiol). 2023 Sep;35(9):586-597. doi: 10.1016/j.clon.2023.05.002. Epub 2023 May 9.

Reference Type DERIVED
PMID: 37225552 (View on PubMed)

Hafeez S, Lewis R, Hall E, Huddart R; RAIDER Trial Management Group. Advancing Radiotherapy for Bladder Cancer: Randomised Phase II Trial of Adaptive Image-guided Standard or Dose-escalated Tumour Boost Radiotherapy (RAIDER). Clin Oncol (R Coll Radiol). 2021 Jun;33(6):e251-e256. doi: 10.1016/j.clon.2021.02.012. Epub 2021 Mar 23. No abstract available.

Reference Type DERIVED
PMID: 33766502 (View on PubMed)

Hafeez S, Webster A, Hansen VN, McNair HA, Warren-Oseni K, Patel E, Choudhury A, Creswell J, Foroudi F, Henry A, Kron T, McLaren DB, Mitra AV, Mostafid H, Saunders D, Miles E, Griffin C, Lewis R, Hall E, Huddart R. Protocol for tumour-focused dose-escalated adaptive radiotherapy for the radical treatment of bladder cancer in a multicentre phase II randomised controlled trial (RAIDER): radiotherapy planning and delivery guidance. BMJ Open. 2020 Dec 31;10(12):e041005. doi: 10.1136/bmjopen-2020-041005.

Reference Type DERIVED
PMID: 33384390 (View on PubMed)

Hafeez S, Lewis R, Griffin C, Hall E, Huddart R. Failing to Close the Gap Between Evidence and Clinical Practice in Radical Bladder Cancer Radiotherapy. Clin Oncol (R Coll Radiol). 2021 Jan;33(1):46-49. doi: 10.1016/j.clon.2020.07.001. Epub 2020 Aug 3. No abstract available.

Reference Type DERIVED
PMID: 32762980 (View on PubMed)

Other Identifiers

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ICR-CTSU/2014/10049

Identifier Type: -

Identifier Source: org_study_id

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