Stereotactic Body Radiation Therapy in Treating Patients With Recurrent Primary Ovarian or Uterine Cancer

Study Overview
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Brief Summary
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This phase I trial studies the side effects and best dose of stereotactic body radiation therapy in treating patients with ovarian or uterine cancer that has come back. Stereotactic body radiation therapy is a specialized radiation therapy that sends x-rays directly to the tumor using smaller doses over several days and may cause less damage to normal tissue.

Detailed Description
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This is a phase I study with a primary objective to determine maximum tolerated dose (MTD) of 3 fraction stereotactic body radiation therapy (SBRT) for abdominopelvic recurrences of ovarian cancer (OC) and uterine papillary serous carcinoma (UPSC). This is a dose escalation study that employs a 3+3 design to determine the MTD. Patients are then monitored closely to determine side effects and adverse events, as well as success rates and tumor response to the radiation therapy.

Official Title
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A Phase I Study of Stereotactic Body Radiation Therapy for Patients With Limited Locoregional Recurrences of Ovarian and Uterine Serous Carcinoma

Conditions
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Recurrent Endometrial Serous Adenocarcinoma, Recurrent Fallopian Tube Carcinoma, Recurrent Ovarian Carcinoma, Recurrent Primary Peritoneal Carcinoma

Intervention / Treatment
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* Other: Laboratory Biomarker Analysis
* Other: Quality-of-Life Assessment
* Other: Questionnaire Administration
* Radiation: Stereotactic Body Radiation Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female patients > 18 years of age. ECOG 0 or 1. Diagnosis of primary ovarian cancer of any histology (patients with diagnoses of fallopian tube and primary peritoneal cancer are also eligible), or primary uterine cancer of papillary serous histology. Pathologic confirmation of eligible histology. Three or fewer total sites of active disease (at least one site of active disease to be treated on study must be confined to the abdomen or pelvis excluding liver and must be < 5 cm in greatest dimension as determined by pre-screening cross-sectional imaging). Additional site(s) of active disease (such as parenchymal liver and lung metastases, or supraclavicular nodal metastases), should be considered for treatment (off study) with radiation, surgery, or another form of local therapy, at the discretion of the study PI. Systemic therapy is allowed but SBRT cannot begin until > or = 7 days after the last cycle of systemic therapy, and systemic therapy cannot be initiated or re-initiated until > or = 7 days after SBRT. There will be no limit on prior lines of systemic therapy. Patients with contraindications to intravenous (IV) contrast administration are still eligible for this study if the tumor can be delineated clearly without IV contrast (at the discretion of the treating radiation oncologist) but will not participate in the functional imaging studies. Exclusion Criteria: Pregnant women. If patients are not status post bilateral salpingo-oopherectomy then pregnancy testing is required. Patients with active collagen vascular disease (CVD), specifically systemic lupus erythematosus or scleroderma. Patients with a history of CVD without evidence of active disease are eligible for enrollment at the discretion of the study PI. Patients with inflammatory bowel disease and/or GI ulcers and/or GI fistulas are eligible but only at the discretion of the study PI after personalized review of their medical history and proximity of SBRT targets to gastrointestinal mucosa. Patients with a separate non-cutaneous cancer diagnosis for which the patient has not been without evidence of disease for at least 5 years.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment (SBRT)<br>Patients undergo Stereotactic Body Radiation Therapy (SBRT) every other day for 3 fractions. | Other: Laboratory Biomarker Analysis<br>* Correlative studies<br>Other: Quality-of-Life Assessment<br>* Ancillary studies<br>* Other names: Quality of Life Assessment;Other: Questionnaire Administration<br>* Ancillary studies<br>Radiation: Stereotactic Body Radiation Therapy<br>* Undergo SBRT<br>* Other names: Stereotactic Ablative Body Radiation Therapy;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum Tolerated Dose | This will be accomplished using the standard 3+3 dose escalation design. Dose Limiting Toxicities (DLTs) will be determined through the NCI CTCAE version 4.03. | After the completion of SBRT treatment through 3 months of followup. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| One Year Local Control | Local Control will be defined as Stable Disease (SD), Partial Response (PR) or Complete Repsonse (CR) according to RECIST 1.1 criteria. Assessed using Kaplan Meier survival curves. | After the completion of SBRT treatment, throughout followup, or death, whichever comes first, up to one year. | 
| Progression Free Survival | The amount of time a patient survives without worsening of disease, according to RECIST 1.1 criteria. Assessed using Kaplan Meier survival curves. | After the completion of SBRT treatment, throughout followup, or death, whichever comes first, up to one year. | 
| Overall Survival | The amount of time a patient survives, with or without progression of disease. Assessed using Kaplan Meier survival curves. | After the completion of SBRT treatment, throughout followup, or death, whichever comes first, up to one year. | 
| Chemotherapy-Free Interval | The amount of time a patient survives without having to undergo re-initiation of chemotherapy. Assessed using Kaplan Meier survival curves. | After the completion of SBRT treatment throughout followup to the re-initiation of chemotherapy, up to one year. | 
| Acute Toxicities | Acute toxicities will be assessed by the NCI CTCAE version 4.03. | During SBRT treatment, throughout followup, or death, whichever comes first, up to 6 weeks post treatment. | 
| Late Toxicities | Delayed toxicities will be assessed by the NCI CTCAE version 4.03. | After the completion of SBRT treatment, throughout followup, or death, whichever comes first, up to one year. | 
| Quality of Life Assessment through Survey | Quality of life will be assessed through the EORTC QLQ-C30 and OV28 questionnaires. | After the completion of SBRT treatment, throughout followup, or death, whichever comes first, up to one year. | 
| Functional Imaging | DCE-CT scans using the Siemens AS open scanner will be assessed according to RECIST 1.1 criteria. | Prior to completion of SBRT, immediately after the completion of SBRT, and 6 weeks after the completion of SBRT. | 
| Profile of SBRT-Associated Immune Response | The Human Immune Monitoring Shared Resource will preform cytometry and cytokine arrays, as well as characterizing activation markers. | Prior to completion of SBRT, 2 weeks after the completion of SBRT, and 6 weeks after the completion of SBRT. |