Non Small Cell Lung Cancer Clinical Trial
Official title:
Isotoxic Intensity Modulated Radiotherapy (IMRT) in Stage III Non Small Cell Lung Cancer (NSCLC) - A Feasibility Study
This study is for patients having a course of chest radiotherapy treatment after receiving
chemotherapy for the treatment of non-small cell lung cancer. Patients with non-small cell
lung cancer have a risk of the tumour in the lung recurring or progressing after treatment.
In this study, we will investigate:
- whether giving a more targeted and individualised type of chest irradiation or
radiotherapy to the lung tumour (known as Isotoxic IMRT), is practical and whether it
causes side effects which can be tolerated
- whether this new method of delivering the radiotherapy can reduce the risk of the tumour
in the lung recurring or progressing
- whether survival can be improved by using this new radiotherapy method
The dose of chest irradiation will be calculated specifically to suit patient's body shape,
the position of the lung cancer, and how close healthy tissues are to the tumour.
Radiotherapy will be delivered twice a day over a maximum period of 4.5 weeks. The duration
of treatment will vary individually according to the delivered dose to the tumour area.
Background:
Approximately 12,000 patients are diagnosed with stage III NSCLC in the UK each year and
their survival is ~15% at 5 years. As the majority of patients are not suitable for the gold
standard treatment (concurrent chemo-radiotherapy (CTRT), novel strategies integrating
radiotherapy (RT) technological advances and radiobiological knowledge need to be evaluated
in patients treated with the alternative treatment option, sequential CTRT. There is solid
evidence that improving local control in lung cancer leads to increased survival. Strategies
to improve local control in stage III NSCLC include dose escalation and individualisation
which are limited by the dose delivered to surrounding normal tissues. We hypothesise that
this will be facilitated by the use of IMRT.
Objectives:
To demonstrate the feasibility of delivering isotoxic RT using IMRT and hyperfractionated
accelerated RT in stage III NSCLC patients who are not suitable for concurrent CTRT.
Endpoints:
Primary endpoint: Delivery of isotoxic IMRT to dose >60 Gy EQD2 (total biologically
equivalent in 2 Gy fraction).
Secondary endpoints: Estimation of the suitability for lung isotoxic IMRT, estimation of
proportion of patients with acute grade 3+ non haematological toxicity, estimation of late
toxicity, estimation of local control/overall survival and development of a robust Quality
Assurance (QA) process for lung IMRT.
Design:
Prospective multicentre, non-randomised feasibility study with early stopping rules.
35 patients will be recruited in this prospective multicentre feasibility study. Stopping
rules are in place to ensure the safety of patients. We estimate that this regimen would be
of added value to a national randomised phase II trial if 80% of the patients can be planned
to a dose >60 Gy EQD2.
Intervention:
Patients with stage III NSCLC, PS 0-2, not suitable for concurrent CTRT, will be treated with
individualised doses of radiation based on pre-specified normal tissue doses (spinal cord,
brachial plexus, lung tissue, heart and great vessels/proximal bronchial tree). Radiotherapy
will be delivered twice-daily over a maximum period of 4.5 weeks using IMRT and the dose of
radiation will be increased until one or more of the organs at risk tolerance or the maximum
dose of 79.2 Gy is reached.
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