Stereotactic Pelvic Adjuvant Radiation TherApy in Cancers of the UteruS

Study Overview
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Brief Summary
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Advanced technology has enabled radiation oncologists to more accurately and precisely target radiation to areas at risk while maximally sparing healthy tissue. A secondary result of these technologic advances has been the increased utilization of hypofractionationed treatment protocols, since the combined ability to better visualize and precisely deliver radiation to target volumes has allowed radiation oncologists to leverage the therapeutic ratio toward higher target doses whilst maintaining safe doses to the pertinent organs-at-risk. The spectrum of hypofractionation ranges from what are considered moderate (ie. 2- 5 Gy / fraction) into the realm of what is more commonly referred to as stereotactic body (SBRT), generally >5 Gy / fraction. There is growing evidence demonstrating both safety and efficacy for SBRT. The investigators propose that these advantages are translatable to the adjuvant treatment of endometrial cancer. The investigators submit that a prescription dose of 30 Gy in 5 fractions. Through precision delivery and careful dosimetry the treatment should be safe and well tolerated with minimal impact on patient quality of life.

Official Title
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Stereotactic Pelvic Adjuvant Radiation TherApy in Cancers of the UteruS): A Phase I/II Study (SPARTACUS)

Conditions
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Endometrial Cancer

Intervention / Treatment
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* Radiation: SBRT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Histologically confirmed endometrial adenocarcinoma Patient is a candidate for adjuvant pelvic radiation (+/- vault brachytherapy), meeting one of the following conditions: Patient has serous, clear cell, carcinosarcoma or differentiated histologies. Outer-half myometrial invasion and FIGO grade 1-2 OR FIGO stage II - IIIC1. Willing and able to give informed consent to participate in this clinical trial. Age ≥18 years. Are to receive adjuvant systemic therapy in addition to pelvic radiotherapy will be eligible provided that there is at minimum a 3-week interval between any radiation treatment and chemotherapy treatments. Willing and able to complete the QLQ-C30 questionnaire with EN-24 companion as described in the study protocol. Primary language of the patient must be English or, if a patient's primary language is not English, they are still able to participate provided the QLQ-C30 and EN-24 is available in their primary language. Exclusion Criteria: Has had prior pelvic radiotherapy. Has a contraindication to pelvic radiotherapy, such as but not limited to a connective tissue disease or inflammatory bowel disease. Has a contraindication to iodinated CT contrast. Has a hip prosthesis.

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: Other
Intervention Model: Single Group Assignment
Interventional Model Description: It's a Phase I feasibility study, 5 fractions (hypofractionation)
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hypofractionated Pelvic Radiation<br> | Radiation: SBRT<br>* Patients will be planned with the aim of delivering 30 Gy in 5 fractions.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acute toxicities | To assess the acute urinary and bowel toxicities associated with adjuvant SBRT treatment in the setting of high-risk endometrial cancer using CTCAE. | Baseline to 12 weeks following RT completion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of life through EORTC QLQ-C30 and EN24 | To assess the effect of adjuvant SBRT treatment on acute and late patient reported health quality of life using EORTC questionnaires. | Study activation through 2 years post-RT | 
| Late toxicities | To assess the late urinary, bowel, and other toxicities associated with adjuvant SBRT treatment in the setting of high-risk endometrial cancer using CTCAE. | 12 weeks post-RT to 2 years post-RT | 
| Local-regional failure | To assess the local-regional failure of adjuvant SBRT treatment by observation of progression or persistence of disease. | Study activation through 2 years post-RT | 
| Disease-free survival | To document the disease-free survival of those treated with adjuvant SBRT | Study activation through 2 years post-RT | 
| Dosimetric feasibility | The number of patients eligible for enrollment at a 30Gy prescription dose based rigid dosimetric constraints, as compared to a 27.5 Gy treatment dose. | Baseline to RT completion |