Reduced Dose Radiotherapy for the Treatment of Indolent Non-Hodgkin Lymphoma

NCT ID: NCT06386315

Last Updated: 2025-11-12

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

PHASE2

Total Enrollment

112 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-05-15

Study Completion Date

2026-05-30

Brief Summary

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This phase II trial compares the safety, side effects and effectiveness of reduced dose radiation therapy to standard of care dose radiation in treating patients with indolent non-Hodgkin lymphoma. Radiation therapy uses high energy x-rays, particles, or radioactive seeds to kill cancer cells and shrink tumors. Standard of care radiation treatment for indolent non-Hodgkin lymphoma is usually delivered in 12 treatments. Studies have shown indolent lymphoma to be sensitive to radiation treatment, however, larger doses have higher rates of toxicities. A reduced radiation dose may be safe, tolerable and/or effective compared to standard of care radiation dose in treating patients with indolent non-Hodgkin lymphoma.

Detailed Description

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PRIMARY OBJECTIVE:

I. To show that the experimental arm (9 Gy in 3 fractions, 8 Gy in 2 fractions, or 10 Gy in 5 fractions) has significantly reduced acute toxicity (grade ≥ 2 adverse events at least possibly related to radiation treatment within 14 days after the end of radiation treatment (according to Common Terminology Criteria for Adverse Events \[CTCAE\] version \[v\]5.0) compared to 24 Gy in 12 fractions.

SECONDARY OBJECTIVES:

I. To evaluate patient reported quality of life. II. To evaluate response rate. III. To evaluate local control rate. IV. To evaluate relapse-free survival.

EXPLORATORY OBJECTIVES:

I. Financial toxicity will be assessed at the end of radiation treatment. II. Financial health care expenditure will be assessed at the end of radiation treatment III. Late toxicity.

CORRELATIVE RESEARCH OBJECTIVES:

I. Biopsies of enrolled patients will be evaluated for pathological assessment of cellular and genetic mutations to correlate them with disease local relapse and radiation resistance.

II. Patients will have their baseline positron emission tomography (PET)/computed tomography (CT) scan undergo auto-segmentation to calculate the functional imaging 18-fluoro-deoxyglucose (FDG) metabolic tumor volume (MTV), total lesions glycolysis (TLG) and maximum standardized uptake volume (SUVmax) of the sites to be treated with involved-site radiation therapy (ISRT) using MIMvista platform to correlate it with disease local relapse and treatment response.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients undergo reduced dose ISRT once daily (QD) over 3, 2, or 5 treatment fractions. Patients also undergo CT or PET/CT throughout the study. Patients may additionally undergo endoscopy during screening and during follow up.

ARM II: Patients undergo standard of care (SOC) radiation therapy QD over 12 treatment fractions. Patients also undergo CT or PET/CT throughout the study. Patients may additionally undergo endoscopy during screening and during follow up.

After completion of study treatment, patients are followed up at days 7 and 14, months 3 and 6, and then every 6 months for up to 2 years post-radiation therapy.

Conditions

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Indolent B-Cell Non-Hodgkin Lymphoma Recurrent Indolent B-Cell Non-Hodgkin Lymphoma Refractory Indolent B-Cell Non-Hodgkin Lymphoma Recurrent Indolent Non-Hodgkin Lymphoma Refractory Indolent Non-Hodgkin Lymphoma

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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ARM 1 (reduced dose ISRT)

Patients undergo reduced dose ISRT once daily (excluding weekends): 9 Gy delivered in 3 treatment fractions or 8 Gy in 2 fractions. At physician discretion, patients may receive 10 Gy in 5 fractions. Patients also undergo CT or PET/CT throughout the study. Patients may additionally undergo endoscopy during screening and during follow up.

Group Type EXPERIMENTAL

Computed Tomography

Intervention Type PROCEDURE

Undergo CT or PET/CT

Endoscopic Procedure

Intervention Type PROCEDURE

Undergo endoscopy

Involved-site Radiation Therapy (3 Fractions)

Intervention Type RADIATION

Undergo ISRT in 3 fractions

Positron Emission Tomography

Intervention Type PROCEDURE

Undergo PET/CT

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

ARM 2 (SOC ISRT)

Patients undergo standard of care (SOC) radiation therapy once daily (excluding weekends): 24 Gy in 12 treatment fractions. Patients also undergo CT or PET/CT throughout the study. Patients may additionally undergo endoscopy during screening and during follow up.

Group Type ACTIVE_COMPARATOR

Computed Tomography

Intervention Type PROCEDURE

Undergo CT or PET/CT

Endoscopic Procedure

Intervention Type PROCEDURE

Undergo endoscopy

Involved-site Radiation Therapy (12 Fractions)

Intervention Type RADIATION

Undergo ISRT in 12 fractions

Positron Emission Tomography

Intervention Type PROCEDURE

Undergo PET/CT

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Interventions

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Computed Tomography

Undergo CT or PET/CT

Intervention Type PROCEDURE

Endoscopic Procedure

Undergo endoscopy

Intervention Type PROCEDURE

Involved-site Radiation Therapy (3 Fractions)

Undergo ISRT in 3 fractions

Intervention Type RADIATION

Involved-site Radiation Therapy (12 Fractions)

Undergo ISRT in 12 fractions

Intervention Type RADIATION

Positron Emission Tomography

Undergo PET/CT

Intervention Type PROCEDURE

Questionnaire Administration

Ancillary studies

Intervention Type OTHER

Other Intervention Names

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CAT CAT Scan Computed Axial Tomography Computerized Axial Tomography Computerized axial tomography (procedure) Computerized Tomography Computerized Tomography (CT) scan CT CT Scan tomography Endoscopic Examination Endoscopy ES ISRT ISRT Medical Imaging, Positron Emission Tomography PET PET Scan Positron emission tomography (procedure) Positron Emission Tomography Scan Positron-Emission Tomography proton magnetic resonance spectroscopic imaging PT

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 18 years
* Histological confirmation of indolent B-cell lymphoma that can include any of the following:

* Follicular lymphoma (grade 1 or 2 or 3A)
* Marginal zone lymphoma (nodal or extranodal)
* Follicle center lymphoma
* Any stage disease
* Initial, refractory, or relapsed disease. If relapse involves the site to be treated there must be evidence of disease progression
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤ 3
* Negative pregnancy test done ≤ 7 days prior to registration, for persons of childbearing potential only
* Provide written informed consent
* Ability to complete questionnaire(s) by themselves or with assistance
* Willing to return to enrolling institution for follow-up visits (during the active monitoring phase of the study). Virtual visits can also be considered as an option for applicable items
* Confirmation from radiation oncologist of suitability to participate in study

Exclusion Criteria

* Any of the following:

* Pregnant women
* Nursing women
* Women of childbearing potential who are unwilling to employ adequate contraception
* T-cell lymphoma
* Receiving treatment for small and chronic lymphocytic lymphoma
* Grade 3B follicular lymphoma
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mayo Clinic

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Bradford S. Hoppe, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

Locations

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Mayo Clinic in Arizona

Scottsdale, Arizona, United States

Site Status RECRUITING

Mayo Clinic in Florida

Jacksonville, Florida, United States

Site Status RECRUITING

Mayo Clinic Health System in Albert Lea

Albert Lea, Minnesota, United States

Site Status RECRUITING

Mayo Clinic Health System - Mankato

Mankato, Minnesota, United States

Site Status RECRUITING

Mayo Clinic in Rochester

Rochester, Minnesota, United States

Site Status RECRUITING

Mayo Clinic Health System-Eau Claire Clinic

Eau Claire, Wisconsin, United States

Site Status RECRUITING

Mayo Clinic Health System-Franciscan Healthcare

La Crosse, Wisconsin, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Clinical Trials Referral Office

Role: CONTACT

Phone: 855-776-0015

Email: [email protected]

Facility Contacts

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Clinical Trials Referral Office

Role: primary

Clinical Trials Referral Office

Role: primary

Clinical Trials Referral Office

Role: primary

Clinical Trials Referral Office

Role: primary

Clinical Trials Referral Office

Role: primary

Clinical Trials Referral Office

Role: primary

Clinical Trials Referral Office

Role: primary

Related Links

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Other Identifiers

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NCI-2024-03242

Identifier Type: REGISTRY

Identifier Source: secondary_id

23-010273

Identifier Type: OTHER

Identifier Source: secondary_id

MC230808

Identifier Type: OTHER

Identifier Source: secondary_id

MC230808

Identifier Type: -

Identifier Source: org_study_id