Abdominal Neuroblastoma Clinical Trial
Official title:
A Phase II Study of Intensity Modulated Radiation Therapy (IMRT) in High Risk Abdominal Neuroblastoma
High risk neuroblastoma (NB) is an aggressive, prevalent non-brain cancer derived from nerve cells of the body. It mostly affects infants, and more children die from this tumor each year than are cured. Standard therapy includes a combination of chemotherapy, surgery, bone marrow transplant, radiation and immunotherapy. NB is very sensitive to radiation, but due to it's aggressive spread pattern, radiation use is currently limited by toxicity. This study seeks to improve delivery of radiation to reduce toxicity by quantifying outcomes, and measuring differences in renal toxicity and organ motion so that radiation can be focused more effectively against tumor while sparing normal tissues and reducing side-effects.
Patients with high-risk abdominal neuroblastoma who receive any high-risk neuroblastoma
treatment regimen will be eligible to enroll prior to surgical resection of the primary
tumor. Following implantation of fiducial markers within the tumor bed and autologous
hematopoietic rescue, patients will begin the planning process for abdominal irradiation;
this requires multiple baseline studies, including computed tomography (CT), magnetic
resonance imaging (MRI), renal scintigraphy, and bloodwork. Most of these tests will be
repeated on a varying schedule over the five year follow-up period of the protocol, in order
to evaluate the impact of conformal radiotherapy on intra-abdominal tissues.
Intensity modulated radiation therapy (IMRT) delivery will follow current conventional
volume-targeting guidelines, however, appropriate application within the abdomen will be
determined by ascertaining intra-abdominal organ motion and the potential for reducing
normal tissue dose, while simultaneously increasing dose delivered to target tissues,
particularly when dose escalation for gross residual disease is required. Concurrent
neuro-hormonal tests, cytokine analyses, functional and morphologic imaging will generate
novel data describing the acute and chronic effects of radiotherapy within the abdomen.
NOTE: This study is currently closed to accrual, however, it is expected to re-open to
accrual later in 2015.
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Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment