Description:
The purpose of this study is to evaluate the safety and effectiveness of combining
high-dose-rate (HDR) brachytherapy with external beam radiotherapy (EBRT) to the pelvis and 6
months of hormonal therapy, otherwise known as short term androgen deprivation therapy
(STAD), as treatment for prostate cancer that has come back in the prostate and pelvic lymph
nodes after prior radiotherapy. The study will examine the side effects of the treatment as
well as the ability of the treatment to get rid of the cancer. This involves the placement of
a radioactive material in the affected area of the prostate temporarily, and then is
subsequently removed using a minimally invasive technique. Participants will also receive
external radiation for 5 weeks targeting the pelvis and giving a higher dose each day to the
suspicious lymph nodes on PET scan. Radiation therapy will start approximately 2 months after
the start of the Androgen Deprivation Therapy (hormone therapy). The hormone therapy consists
of two medications, an oral medication taken daily 2 months before starting radiation therapy
until the last of the radiation therapy and an injection of a medication which is given 2
months prior to the start of radiation. Patient are then followed at specific time intervals
to evaluate the treatment side effects and cancer control
Title
- Brief Title: BEACON: HDR Brachytherapy, EBRT and STAD for the Treatment of Local and Pelvic Recurrence of Prostate Cancer After Radiation Therapy
- Official Title: BEACON - A Phase I/II Study of High-dose-rate Brachytherapy and External Beam and Short-term Androgen Deprivation COmbined for the Treatment of Men With Fluciclovine PET Pelvic Nodal Uptake in Locally Recurrent Prostate Cancer After Prior Definitive Radiotherapy
Clinical Trial IDs
- ORG STUDY ID:
210546
- NCT ID:
NCT03553602
Conditions
- Prostate Cancer - Recurrent
Purpose
The purpose of this study is to evaluate the safety and effectiveness of combining
high-dose-rate (HDR) brachytherapy with external beam radiotherapy (EBRT) to the pelvis and 6
months of hormonal therapy, otherwise known as short term androgen deprivation therapy
(STAD), as treatment for prostate cancer that has come back in the prostate and pelvic lymph
nodes after prior radiotherapy. The study will examine the side effects of the treatment as
well as the ability of the treatment to get rid of the cancer. This involves the placement of
a radioactive material in the affected area of the prostate temporarily, and then is
subsequently removed using a minimally invasive technique. Participants will also receive
external radiation for 5 weeks targeting the pelvis and giving a higher dose each day to the
suspicious lymph nodes on PET scan. Radiation therapy will start approximately 2 months after
the start of the Androgen Deprivation Therapy (hormone therapy). The hormone therapy consists
of two medications, an oral medication taken daily 2 months before starting radiation therapy
until the last of the radiation therapy and an injection of a medication which is given 2
months prior to the start of radiation. Patient are then followed at specific time intervals
to evaluate the treatment side effects and cancer control
Detailed Description
Salvage regional and local radiation is frequently utilized across multiple disease sites in
oncology for patients who have failed initial radiotherapy. However, in prostate cancer, due
to the concern that nodal involvement is a manifestation of widespread distant disease, this
type of approach has not typically been pursued. However, with newer imaging modalities such
as fluciclovine PET, PSMA pet, and C11 PET, physicians are identifying nodal disease and
excluding distant disease better than they ever have before. Thus, in the modern era regional
control may translate to improved long-term biochemical control, and prevent the morbidity
and mortality associated with clinical progression of recurrent prostate cancer
Thus, in patients who recur both in the prostate and in the pelvic lymph nodes, treating both
with radiation could result in meaningful clinical efficacy for patients-similar to other
disease sites. However, there are limited data exploring the feasibility and safety of this
combination. Therefore, the investigators are conducting this trial, which combines salvage
HDR brachytherapy to the local recurrence of the prostate cancer with EBRT to the pelvic
lymph nodes, and short-term hormonal therapy, in this group of patients. The investigators
hypothesize that this approach can safely be performed without excess toxicity.
Once a patient is deemed eligible for the study and has signed the informed consent form, the
patient will start hormone therapy with a LHRH Agonist medication which is an intramuscular
injection which patients will receive every 3-6 months for 6 months. Within 10 days of the
LHRH injection the patient must start an anti-androgen pill and will take the pill once a day
until the last day of radiation. Radiation Therapy will start approximate 2 months after the
start of the hormone therapy. Patients will undergo 2 implants with 1 fraction of 12 Gy
delivered with each implant, scheduled 1-2 weeks apart when possible, although longer or
shorter intervals are acceptable with PI approval. The implant procedure will be done under
general anesthesia. Patients will also receive the external beam radiotherapy (for 5 weeks),
starting before or after the brachytherapy treatment. Patients will also be asked to complete
2 short quality of life questionnaires before they receive treatment and at follow up visits.
Patient will follow up with the radiation oncologist for an exam at 1 month, 3 months, 6
months and 12 months after treatment and then every 6 months for 4 more years then annually
thereafter.
Trial Arms
| Name | Type | Description | Interventions |
|---|
| HDR Brachytherapy + EBRT + STAD | Experimental | Day 1: HDR Brachytherapy implant: 2 fractions of 12 Gy to prostate/ proximal SV.
EBRT: 50.4 Gy in 28 fractions to the pelvic lymph nodes +/- para-aortic nodes, with SIB up to 70 Gy to the PET positive lesions.
6 months hormonal therapy(LHRH agonist and antiandrogen [until the end of radiotherapy]) | |
Eligibility Criteria
Inclusion Criteria
- Biopsy proven locally recurrent adenocarcinoma of the prostate after the completion of
definitive radiation therapy for initially diagnosed prostate cancer.
- Initial cancer diagnosis that fits these specific criteria:
- Stages cT1-T3a
- Nx or N0
- Mx or M0
- Eligible initial definitive radiotherapy modalities include:
- External beam radiotherapy, with photon or proton beam therapy
- Definitive Brachytherapy
- Stereotactic Body Radiotherapy
- Fluciclovine-positive pelvic nodes (as determined by an interpreting radiologist or
nuclear medicine physician) in the pelvic nodal region (defined as the pelvic nodal
regions up to the common iliac nodal region) without any evidence of lymph node
involvement outside of this area or distant metastases
- Candidate for hormonal therapy.
- Current ECOG Performance status Scale 0-2 (Appendix D)
- Current International Prostate Symptom Score (IPSS) < 20 (Appendix B)
- Age >18
- The patient must be medically suitable to receive general or spinal anesthesia.
- AST, ALT, and alkaline phosphatase < 2 x upper institutional limit within 3 months of
registration.
- The patient must be able and willing to sign a study-specific written informed consent
form before study entry.
Exclusion Criteria
- Preregistration radiation-related GI or GU toxicity (for any reason) grade ≥ 3 as
defined in CTCAE version 4.03. That is, grade ≥ 3 GU or GI toxicity after first course
of radiotherapy
- Treatment to a "whole pelvis" field with initial radiotherapy
- Patients with distant metastases (such as to the bone, visceral organs, and lymph
nodes other than the pelvic nodes including the common iliac nodes).
- Patients receiving any other investigational agents.
- Uncontrolled inter-current illness including, but not limited to, ongoing or active
infection, severely symptomatic congestive heart failure, cardiac arrhythmia, recent
myocardial infarction in last 6 months, or psychiatric illness/social situations that
could limit compliance with study requirements.
- Patients who have received chemotherapy or immunotherapy within one month prior to
study enrollment, other than ADT.
| Maximum Eligible Age: | 99 Years |
| Minimum Eligible Age: | 18 Years |
| Eligible Gender: | Male |
| Healthy Volunteers: | No |
Primary Outcome Measures
| Measure: | Toxicity rate |
| Time Frame: | 24 months |
| Safety Issue: | |
| Description: | The primary outcome in this study is the number of acute grade ≥3 radiation-related genitourinary and gastrointestinal toxicities as described by the Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. |
Details
| Phase: | Phase 1/Phase 2 |
| Primary Purpose: | Interventional |
| Overall Status: | Recruiting |
| Lead Sponsor: | Loyola University |
Trial Keywords
- Prostate Cancer
- HDR brachytherapy
- Recurrent Prostate Cancer
- Oligometastasis
- Salvage Brachytherapy
- Salvage Radiotherapy
Last Updated
June 2, 2020
