Cryoablation Combined With Stereotactic Body Radiation Therapy for the Treatment of Painful Bone Metastases, the CROME Trial

NCT ID: NCT04693377

Last Updated: 2025-10-27

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 40 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-03-16
• Study Completion Date: 2027-04-01

Brief Summary

This trial compares cryoablation combined with stereotactic body radiation therapy to stereotactic body radiation therapy alone to see how well they work in treating patients with pain from cancer that has spread to the bones (bone metastases). Bone is a common site of metastasis in advanced cancer, and bone metastases often result in debilitating cancer-related pain. The current standard of care to treat painful bone metastases is radiation therapy alone. However, many patients do not get adequate pain relief from radiation therapy alone. Another type of therapy that may be used to provide pain relief from bone metastases is cryoablation. Cryoablation is a procedure in which special needles are inserted into the tumor site. These needles grow ice balls at their tips to freeze and kill cancer cells. The goal of this trial is to compare how well cryoablation in combination with radiation therapy works to radiation therapy alone when given to cancer patients to provide pain relief from bone metastases.

Detailed Description

PRIMARY OBJECTIVE:

I. To determine the efficacy of cryoablation in combination with stereotactic body radiation therapy (SBRT) or SBRT only for the treatment of painful bone metastases.

SECONDARY OBJECTIVES:

I. To assess for narcotics utilization by daily morphine equivalent dose. II. To assess duration of pain response reported by International Pain Response Criteria.

III. To assess for local tumor control. IV. To assess for changes in patient quality of life with Brief Pain Inventory (BPI) score.

V. To assess for adverse event rates. VI. To assess incidence and severity of adverse events/toxicity. VII. To assess technical success for cryoablation.

EXPLORATORY OBJECTIVE:

I. To investigate the local microenvironmental changes following SBRT and cryoablation combined with SBRT to bone metastases.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM A: Patients undergo stereotactic body radiation therapy for 1 fraction.

ARM B: Patients undergo cryoablation. Within 10 days after cryoablation, patients undergo stereotactic body radiation therapy for 1 fraction.

After completion of study treatment, patients are followed up at 1, 2, 3, 4, 8, 12, 16, 20, and 24 weeks.

Conditions

Castration-Resistant Prostate Carcinoma; Metastatic Colorectal Carcinoma; Metastatic Malignant Neoplasm in the Bone; Metastatic Malignant Solid Neoplasm; Metastatic Melanoma; Metastatic Prostate Carcinoma; Metastatic Renal Cell Carcinoma; Metastatic Sarcoma; Metastatic Thyroid Gland Carcinoma; Metastatic Urothelial Carcinoma; Stage IV Colorectal Cancer AJCC v8; Stage IV Prostate Cancer AJCC v8; Stage IV Renal Cell Cancer AJCC v8; Stage IVA Colorectal Cancer AJCC v8; Stage IVA Prostate Cancer AJCC v8; Stage IVB Colorectal Cancer AJCC v8; Stage IVB Prostate Cancer AJCC v8; Stage IVC Colorectal Cancer AJCC v8

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: SUPPORTIVE_CARE
• Blinding Strategy: NONE

Study Groups

Arm A (SBRT)

Patients undergo stereotactic body radiation therapy for 1 fraction.

Group Type: ACTIVE_COMPARATOR

Quality-of-Life Assessment

Intervention Type: OTHER

Ancillary studies

Stereotactic Body Radiation Therapy

Intervention Type: RADIATION

Undergo stereotactic body radiation therapy

Arm B (cryoablation, SBRT)

Patients undergo cryoablation. Within 10 days after cryoablation, patients undergo stereotactic body radiation therapy for 1 fraction. Alternatively, patients may receive stereotactic body radiation therapy initially, followed by cryoablation."

Group Type: EXPERIMENTAL

Cryosurgery

Intervention Type: PROCEDURE

Undergo cryoablation

Quality-of-Life Assessment

Intervention Type: OTHER

Ancillary studies

Stereotactic Body Radiation Therapy

Intervention Type: RADIATION

Undergo stereotactic body radiation therapy

Interventions

Cryosurgery

Undergo cryoablation

Intervention Type: PROCEDURE

Quality-of-Life Assessment

Ancillary studies

Intervention Type: OTHER

Stereotactic Body Radiation Therapy

Undergo stereotactic body radiation therapy

Intervention Type: RADIATION

Other Intervention Names

Ablation, Cryo; Cryoablation; cryosurgical ablation; Quality of Life Assessment; SABR; SBRT; Stereotactic Ablative Body Radiation Therapy

Eligibility Criteria

Inclusion Criteria

• Patient must have a primary diagnosis of malignancy and radiographic evidence of bone metastases. Eligible tumor histologies include the following malignancies with low alpha/beta ratios: renal cell carcinoma, urothelial carcinomas, castration-resistant prostate cancer, sarcoma, thyroid carcinoma, colorectal carcinoma, and melanoma
• A target lesion the meets the following criteria:

• The target lesion must be amenable to both cryoablation and SBRT, as determined by the study principal investigators (PIs)
• The target lesion must be =< 7cm
• The pain due to the target lesion must be at least 4/10 based on the BPI pain scale
• Pain from the metastatic site must correlate with an identifiable tumor on computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound (US) imaging
• Life expectancy >= 3 months
• Platelet count > 50,000/mm^3 within 6 weeks of screening
• International normalized ratio (INR) < 1.5 within 6 weeks of screening
• If taking antiplatelet or anticoagulation medication, it must be able to be discontinued 48 hours prior to the procedure or at the discretion of the PI (e.g., aspirin, ibuprofen, low molecular weight heparin [LMWH] preparations)
• Eastern Cooperative Oncology Group (ECOG) performance status =< 1 (Karnofsky >= 70%) within 6 weeks of screening
• Evidence of post-menopausal status or negative urinary or serum pregnancy test for female pre-menopausal patients. Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply: Women < 50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone and follicle-stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilization. Women >= 50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses > 1 year ago, had chemotherapy-induced menopause with last menses > 1 year ago, or underwent surgical sterilization
• All lines of prior systemic therapy are permissible. Standard concurrent chemotherapy, immunotherapy, or targeted therapy are permissible
• Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria

• Prior locoregional therapy to target lesion, including ablation of any modality, embolization, radiation, or surgery
• Patient may not be receiving any other investigational agents. Standard concurrent chemotherapy, immunotherapy, or targeted therapy will be allowed
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, interstitial lung disease, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Pregnant or nursing women; women of childbearing potential unless using effective contraception as determined by the investigator
• Target lesions that involve the spinal column or calvarium
• Absolute neutrophil count < 1000 mm^3 within 6 weeks of screening
• Active infection
• Presence of confirmed pathologic fracture at the target lesion not amenable to percutaneous stabilization
• Lesions that involve a weight-bearing long bone of the lower extremity with the tumor causing > 50% loss of cortical bone. Lesions involving the hands and feet

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

M.D. Anderson Cancer Center

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Rahul A Sheth, MD

Role: PRINCIPAL_INVESTIGATOR

M.D. Anderson Cancer Center

Locations

M D Anderson Cancer Center

Houston, Texas, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Rahul A. Sheth, MD

Role: CONTACT

rasheth@mdanderson.org

713-745-0652

Facility Contacts

Rahul A. Sheth, MD

Role: primary

713-745-0652

Related Links

http://www.mdanderson.org

University of Texas MD Anderson Cancer Center Website

Other Identifiers

NCI-2020-07368

Identifier Type: REGISTRY

Identifier Source: secondary_id

2019-1234

Identifier Type: OTHER

Identifier Source: secondary_id

2019-1234

Identifier Type: -

Identifier Source: org_study_id