A Randomized Phase III Trial of Stereotactic Ablative Radiotherapy for Patients With Up to 10 Oligometastases and a Synchronous Primary Tumor.

NCT ID: NCT05717166

Last Updated: 2025-12-31

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

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

180 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-10-06

Study Completion Date

2029-04-30

Brief Summary

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This study is a phase III multi-institutional randomized trial. Patients will be randomized in a 1:2 ratio between current standard of care treatment (Arm 1) vs. standard of care treatment + SABR (Arm 2) to sites of known disease.

Patients will be stratified by two of the strongest prognostic factors, based on a large multi-institutional analysis3: histology (Group 1: hormone-sensitive prostate cancer, breast, or renal; Group 2: all others), and number of metastases (Group 1: 1-3; Group 2: 4-10).

Detailed Description

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Conditions

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Metastatic Tumor

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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Standard Arm (Arm 1)

Radiotherapy for patients in the standard arm should follow the principles of palliative radiotherapy as per the individual institution, with the goal of alleviating symptoms or preventing imminent complications.

Group Type ACTIVE_COMPARATOR

Palliative Radiotherapy

Intervention Type RADIATION

Radiotherapy for patients in the standard arm should follow the principles of palliative radiotherapy as per the individual institution, with the goal of alleviating symptoms or preventing imminent complications. Recommended dose fractionations in this arm will include 8 Gy in 1 fraction, 20 Gy in 5 fractions, and 30 Gy in 10 fractions.

Chemotherapy

Intervention Type DRUG

Pre-specified based on the standard of care approach for that patient.

Hormone therapy

Intervention Type DRUG

Pre-specified based on the standard of care approach for that patient.

Immunotherapy

Intervention Type DRUG

Pre-specified based on the standard of care approach for that patient.

Targeted Systemic Therapy

Intervention Type DRUG

Pre-specified based on the standard of care approach for that patient.

Observation

Intervention Type OTHER

Pre-specified based on the standard of care approach for that patient.

Experimental Arm (Arm 2)

Consists of treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable (e.g. surgery, RFA, fractionated radiation, chemoradiation) if those are deemed to be preferable by the treating oncologists.

Group Type EXPERIMENTAL

Palliative Radiotherapy

Intervention Type RADIATION

Radiotherapy for patients in the standard arm should follow the principles of palliative radiotherapy as per the individual institution, with the goal of alleviating symptoms or preventing imminent complications. Recommended dose fractionations in this arm will include 8 Gy in 1 fraction, 20 Gy in 5 fractions, and 30 Gy in 10 fractions.

Chemotherapy

Intervention Type DRUG

Pre-specified based on the standard of care approach for that patient.

Hormone therapy

Intervention Type DRUG

Pre-specified based on the standard of care approach for that patient.

Immunotherapy

Intervention Type DRUG

Pre-specified based on the standard of care approach for that patient.

Targeted Systemic Therapy

Intervention Type DRUG

Pre-specified based on the standard of care approach for that patient.

Observation

Intervention Type OTHER

Pre-specified based on the standard of care approach for that patient.

Stereotactic Ablative Radiotherapy

Intervention Type RADIATION

The primary tumor may be treated with SABR or with other local modalities at the discretion of the treating team and/or the local multidisciplinary tumor board.

Preferred doses are 20 Gy in 1 fraction, 30 Gy in 3 fractions (every second day), and 35 Gy in 5 fractions (daily).

Surgery

Intervention Type PROCEDURE

Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists.

The primary tumor may be treated with SABR or with other local modalities at the discretion of the treating team and/or the local multidisciplinary tumor board. Because of the convenience in using SABR for all lesions, non-SABR modalities should only be used if they are likely to provide a benefit over SABR.

Radiofrequency Therapy (RFA)

Intervention Type OTHER

Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists.

Fractionated Radiation

Intervention Type RADIATION

Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists.

Tumors in the esophagus, stomach, small intestine or colon should be treated with either fractionated radiation or a lower SABR dose (e.g. 25 Gy in 5 fractions) to minimize the risk of perforation.

Interventions

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Palliative Radiotherapy

Radiotherapy for patients in the standard arm should follow the principles of palliative radiotherapy as per the individual institution, with the goal of alleviating symptoms or preventing imminent complications. Recommended dose fractionations in this arm will include 8 Gy in 1 fraction, 20 Gy in 5 fractions, and 30 Gy in 10 fractions.

Intervention Type RADIATION

Chemotherapy

Pre-specified based on the standard of care approach for that patient.

Intervention Type DRUG

Hormone therapy

Pre-specified based on the standard of care approach for that patient.

Intervention Type DRUG

Immunotherapy

Pre-specified based on the standard of care approach for that patient.

Intervention Type DRUG

Targeted Systemic Therapy

Pre-specified based on the standard of care approach for that patient.

Intervention Type DRUG

Observation

Pre-specified based on the standard of care approach for that patient.

Intervention Type OTHER

Stereotactic Ablative Radiotherapy

The primary tumor may be treated with SABR or with other local modalities at the discretion of the treating team and/or the local multidisciplinary tumor board.

Preferred doses are 20 Gy in 1 fraction, 30 Gy in 3 fractions (every second day), and 35 Gy in 5 fractions (daily).

Intervention Type RADIATION

Surgery

Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists.

The primary tumor may be treated with SABR or with other local modalities at the discretion of the treating team and/or the local multidisciplinary tumor board. Because of the convenience in using SABR for all lesions, non-SABR modalities should only be used if they are likely to provide a benefit over SABR.

Intervention Type PROCEDURE

Radiofrequency Therapy (RFA)

Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists.

Intervention Type OTHER

Fractionated Radiation

Treatment to the primary tumor and metastases, with SABR preferred, but other options all allowable if those are deemed to be preferable by the treating oncologists.

Tumors in the esophagus, stomach, small intestine or colon should be treated with either fractionated radiation or a lower SABR dose (e.g. 25 Gy in 5 fractions) to minimize the risk of perforation.

Intervention Type RADIATION

Other Intervention Names

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Cytotoxic Systemic Therapy Hormonal Systemic Therapy

Eligibility Criteria

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Inclusion Criteria

* Age 18 years or older
* Willing to provide informed consent
* Karnofsky performance status \> 60
* Life expectancy \> 6 months
* Histologically confirmed malignancy with metastatic disease detected on imaging. Biopsy of metastasis is preferred, but not required.
* Total number of metastases 1-10 at the time of enrollment, with a primary tumor also present
* Restaging completed within 12 weeks prior to randomization (see section 5.1)
* For patients receiving thoracic radiotherapy, the enrolling physician must confirm there are no computed tomography (CT) changes suggestive of fibrotic interstitial lung disease (ILD) (i.e. reticular changes, traction bronchiectasis, or honeycombing) reported on any prior CT scans. If any are present, the patient must be assessed by a respirologist to rule out ILD prior to enrollment.
* 10 or fewer lifetime metastases from the cancer for which participants are being enrolled

Exclusion Criteria

* Serious medical comorbidities precluding radiotherapy. These include ILD in patients requiring thoracic radiation, Crohn's disease in patients where the gastrointestinal (GI) tract will receive radiotherapy, or ulcerative colitis where the bowel will receive radiotherapy and connective tissue disorders such as lupus or scleroderma.
* For patients with liver metastases, moderate/severe liver dysfunction (Child Pugh B or C); please see the Child-Pugh score calculator.
* Substantial overlap with a previously treated radiation volume. Prior radiotherapy in general is allowed, as long as the composite plan meets dose constraints herein. For patients treated with radiation previously, biological effective dose calculations should be used to equate previous doses to the tolerance doses listed in Appendix 1. All such cases must be discussed with a member of the study steering committee.
* Malignant pleural effusion
* Inability to treat all sites of disease
* Brain metastasis \> 3 cm in size or a total volume of brain metastases greater than 30 cc.
* Metastasis in the brainstem
* Clinical or radiologic evidence of spinal cord compression
* Metastatic disease that invades any of the following: GI tract (including esophagus, stomach, small or large bowel), or skin
* Pregnant or lactating women
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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David Palma

OTHER

Sponsor Role lead

Responsible Party

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David Palma

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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BC Cancer - Centre for the North

Prince George, British Columbia, Canada

Site Status NOT_YET_RECRUITING

BC Cancer - Vancouver

Vancouver, British Columbia, Canada

Site Status RECRUITING

London Regional Cancer Program of the Lawson Health Research Institute

London, Ontario, Canada

Site Status RECRUITING

Centre Hospitalier de l'Université de Montréal-CHUM

Montreal, Quebec, Canada

Site Status RECRUITING

Universitätsspital Zürich

Zurich, , Switzerland

Site Status RECRUITING

Countries

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Canada Switzerland

Central Contacts

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David Palma, MD, PhD

Role: CONTACT

Phone: 519-685-8650

Email: [email protected]

Facility Contacts

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Tina Zhang, MD

Role: primary

David Palma, MD, PhD

Role: primary

Toni Vu

Role: primary

Matthias Guckenberger, MD

Role: primary

References

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Palma DA, Giuliani ME, Correa RJM, Schneiders FL, Harrow S, Guckenberger M, Zhang T, Bahig H, Senthi S, Chung P, Olson R, Lock M, Raman S, Bauman GS, Lok BH, Laba JM, Glicksman RM, Nguyen TK, Lang P, Helou J, Goodman CD, Mendez LC, van Rossum PSN, Warner A, Gaede S, Allan AL. A randomized phase III trial of stereotactic ablative radiotherapy for patients with up to 10 oligometastases and a synchronous primary tumor (SABR-SYNC): study protocol. BMC Palliat Care. 2024 Sep 7;23(1):223. doi: 10.1186/s12904-024-01548-7.

Reference Type DERIVED
PMID: 39244532 (View on PubMed)

Other Identifiers

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ReDA 13176

Identifier Type: -

Identifier Source: org_study_id