FLARE RT for Patients With Stage IIB-IIIB Non-small Cell Lung Cancer: Personalizing Radiation Therapy Using PET/CT and SPECT/CT Imaging

NCT ID: NCT02773238

Last Updated: 2024-08-14

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

51 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-05-20

Study Completion Date

2023-12-01

Brief Summary

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This phase II trial studies how well positron emission tomography (PET)/computed tomography (CT) and single positron emission computed tomography (SPECT)/CT imaging works in improving radiation therapy treatment in patients with stage IIB-IIIB non-small cell lung cancer. PET/CT imaging mid-way through treatment may be able to accurately show how well radiation therapy and chemotherapy are working. SPECT/CT imaging may be able to tell which parts of the lung tissue are healthier than others. Based on the result of the imaging, treatment adjustments may be made to the radiation therapy to improve survival and decrease toxicity.

Detailed Description

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OUTLINE: This is a dose-escalation study of radiation therapy.

Patients undergo functional avoidance radiation therapy during weeks 1-3. Patients undergo fludeoxyglucose F-18 FDG PET/CT at baseline, 3 weeks, and 3 months post-radiation therapy and undergo technetium Tc-99m albumin aggregated (99mTc-MAA) and technetium Tc-99m sulfur colloid SPECT/CT radiation therapy at baseline and 3 months post-radiation therapy. Baseline PET/CT must be performed at University of Washington Medical Center/Seattle Cancer Care Alliance and be within one month of treatment start, therefore some patients may need to repeat a baseline PET/CT if their PET/CT is from an outside institution or \> 1 month old. Patients not responding to treatment at 3 weeks, will receive an increased daily radiation therapy dosage.

After completion of study treatment, patients are followed up for 2 years.

Conditions

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Stage IIB Lung Non-Small Cell Carcinoma AJCC v7 Stage IIIA Lung Non-Small Cell Cancer AJCC v7 Stage IIIB Lung Non-Small Cell Cancer AJCC v7

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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Treatment

Patients undergo functional avoidance radiation therapy during weeks 1-3. Patients undergo fludeoxyglucose F-18 FDG PET/CT at baseline, 3 weeks, and 3 months post-radiation therapy and undergo technetium Tc-99m albumin aggregated (99mTc-MAA) and technetium Tc-99m sulfur colloid SPECT/CT radiation therapy at baseline and 3 months post-radiation therapy. Baseline PET/CT must be performed at University of Washington Medical Center/Seattle Cancer Care Alliance and be within one month of treatment start, therefore some patients may need to repeat a baseline PET/CT if their PET/CT is from an outside institution or \> 1 month old. Patients not responding to treatment at 3 weeks, will receive an increased daily radiation therapy dosage.

Group Type EXPERIMENTAL

Computed Tomography

Intervention Type PROCEDURE

Undergo FDG PET/CT

Computed Tomography

Intervention Type PROCEDURE

Undergo Tc-99m MAA or Tc-99m DTPA

Fludeoxyglucose F-18

Intervention Type RADIATION

Undergo FDG PET/CT

Laboratory Biomarker Analysis

Intervention Type OTHER

Correlative studies

Positron Emission Tomography

Intervention Type PROCEDURE

Undergo FDG PET/CT

Radiation Therapy

Intervention Type RADIATION

Undergo functional avoidance radiation therapy

Single Photon Emission Computed Tomography

Intervention Type PROCEDURE

Undergo Tc-99m MAA or Tc-99m Undergo Tc-99m sulfur colloid SPECT/CT

Technetium Tc-99m Albumin Aggregated

Intervention Type RADIATION

Undergo Tc-99m MAA SPECT/CT

Technetium Tc-99m Sulfur Colloid

Intervention Type RADIATION

Undergo Tc-99m sulfur colloid

Interventions

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Computed Tomography

Undergo FDG PET/CT

Intervention Type PROCEDURE

Computed Tomography

Undergo Tc-99m MAA or Tc-99m DTPA

Intervention Type PROCEDURE

Fludeoxyglucose F-18

Undergo FDG PET/CT

Intervention Type RADIATION

Laboratory Biomarker Analysis

Correlative studies

Intervention Type OTHER

Positron Emission Tomography

Undergo FDG PET/CT

Intervention Type PROCEDURE

Radiation Therapy

Undergo functional avoidance radiation therapy

Intervention Type RADIATION

Single Photon Emission Computed Tomography

Undergo Tc-99m MAA or Tc-99m Undergo Tc-99m sulfur colloid SPECT/CT

Intervention Type PROCEDURE

Technetium Tc-99m Albumin Aggregated

Undergo Tc-99m MAA SPECT/CT

Intervention Type RADIATION

Technetium Tc-99m Sulfur Colloid

Undergo Tc-99m sulfur colloid

Intervention Type RADIATION

Other Intervention Names

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CAT CAT Scan Computerized Axial Tomography computerized tomography CT CT SCAN tomography CAT CAT Scan Computerized Axial Tomography computerized tomography CT CT SCAN tomography 18FDG FDG fludeoxyglucose F 18 Fludeoxyglucose F18 Fluorine-18 2-Fluoro-2-deoxy-D-Glucose Fluorodeoxyglucose F18 Medical Imaging, Positron Emission Tomography PET PET Scan Positron Emission Tomography Scan Positron-Emission Tomography proton magnetic resonance spectroscopic imaging Cancer Radiotherapy Irradiate Irradiated irradiation RADIATION Radiotherapeutics radiotherapy RT Therapy, Radiation Medical Imaging, Single Photon Emission Computed Tomography Single Photon Emission Tomography single-photon emission computed tomography SPECT SPECT imaging SPECT SCAN SPET tomography, emission computed, single photon Tomography, Emission-Computed, Single-Photon Tc 99m-labeled MAA Technetium Tc 99m-Labeled Macroaggregated Albumin Tc 99m sulfur colloid Tc-99m SC technetium Tc 99m sulfur colloid

Eligibility Criteria

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Inclusion Criteria

* Pathologically proven (either histologic or cytologic) diagnosis of stage IIB-IIIB non-small cell lung cancer (NSCLC); according to American Joint Committee on Cancer (AJCC) staging, 7th edition

* Staging workup must include: brain imaging (CT head or magnetic resonance imaging \[MRI\] brain) and PET/CT
* Pleural effusions must have cytology to rule out malignant involvement unless too small to undergo thoracentesis per radiology
* Patients must be considered unresectable or inoperable
* Patient must not have received prior radiation for this lung cancer
* Patients must be having concurrent chemotherapy
* Nodal recurrences can be treated on this protocol but prior curative surgery for lung cancer must have been at least 6 months prior to the nodal recurrence
* Patients must have measurable or evaluable disease that is FDG avid with standardized uptake value (SUV) \> 3 on PET/CT
* Zubrod performance status 0-1
* PFTs including forced expiratory volume in 1 second (FEV1) within 26 weeks prior to registration; for FEV1, the best value obtained pre- or post-bronchodilator must be \>= 0.8 liters/second or \>= 50% predicted
* Blood cell count (CBC)/differential obtained within 8 weeks prior to registration on study
* Absolute neutrophil count (ANC) \>= 1,800 cells/mm\^3
* Platelets \>= 100,000 cells/mm\^3
* Hemoglobin \>= 10.0 g/dl (Note: The use of transfusion or other intervention to achieve hemoglobin (Hgb) \>= 10.0 g/dl is acceptable)
* Serum creatinine within normal institutional limits or creatinine clearance \>= 40 ml/min
* Bilirubin must be within or below normal institutional limits
* Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) \< 2.5 x the institutional upper limit of normal (IULN)
* Patient must sign study specific informed consent prior to study entry

Exclusion Criteria

* \> 10% unintentional weight loss within the past month
* Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years; non-invasive conditions such as carcinoma in situ of the breast, oral cavity, or cervix are all permissible
* Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields
* Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

University of Washington

OTHER

Sponsor Role lead

Responsible Party

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Jing Zeng

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jing Zeng

Role: PRINCIPAL_INVESTIGATOR

Fred Hutch/University of Washington Cancer Consortium

Locations

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Fred Hutch/University of Washington Cancer Consortium

Seattle, Washington, United States

Site Status

SCCA Proton Therapy Center

Seattle, Washington, United States

Site Status

Countries

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United States

References

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Duan C, Liu Q, Wang J, Tong Q, Bai F, Han J, Wang S, Hippe DS, Zeng J, Bowen SR. GWO+RuleFit: rule-based explainable machine-learning combined with heuristics to predict mid-treatment FDG PET response to chemoradiation for locally advanced non-small cell lung cancer. Phys Med Biol. 2024 Jul 23;69(15):10.1088/1361-6560/ad6118. doi: 10.1088/1361-6560/ad6118.

Reference Type DERIVED
PMID: 38981590 (View on PubMed)

Horn KP, Thomas HMT, Vesselle HJ, Kinahan PE, Miyaoka RS, Rengan R, Zeng J, Bowen SR. Reliability of Quantitative 18F-FDG PET/CT Imaging Biomarkers for Classifying Early Response to Chemoradiotherapy in Patients With Locally Advanced Non-Small Cell Lung Cancer. Clin Nucl Med. 2021 Nov 1;46(11):861-871. doi: 10.1097/RLU.0000000000003774.

Reference Type DERIVED
PMID: 34172602 (View on PubMed)

Duan C, Chaovalitwongse WA, Bai F, Hippe DS, Wang S, Thammasorn P, Pierce LA, Liu X, You J, Miyaoka RS, Vesselle HJ, Kinahan PE, Rengan R, Zeng J, Bowen SR. Sensitivity analysis of FDG PET tumor voxel cluster radiomics and dosimetry for predicting mid-chemoradiation regional response of locally advanced lung cancer. Phys Med Biol. 2020 Oct 7;65(20):205007. doi: 10.1088/1361-6560/abb0c7.

Reference Type DERIVED
PMID: 33027064 (View on PubMed)

Bowen SR, Hippe DS, Chaovalitwongse WA, Duan C, Thammasorn P, Liu X, Miyaoka RS, Vesselle HJ, Kinahan PE, Rengan R, Zeng J. Voxel Forecast for Precision Oncology: Predicting Spatially Variant and Multiscale Cancer Therapy Response on Longitudinal Quantitative Molecular Imaging. Clin Cancer Res. 2019 Aug 15;25(16):5027-5037. doi: 10.1158/1078-0432.CCR-18-3908. Epub 2019 May 29.

Reference Type DERIVED
PMID: 31142507 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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NCI-2016-00543

Identifier Type: REGISTRY

Identifier Source: secondary_id

9599

Identifier Type: OTHER

Identifier Source: secondary_id

R01CA204301

Identifier Type: NIH

Identifier Source: secondary_id

View Link

RG3116002

Identifier Type: OTHER

Identifier Source: secondary_id

9599

Identifier Type: -

Identifier Source: org_study_id

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