Stereotactic Body Radiation Therapy in Treating Patients With Liver Cancer That Cannot Be Removed by Surgery

Study Overview
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Brief Summary
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This pilot clinical trial studies stereotactic body radiation therapy in treating patients with liver cancer that cannot be removed by surgery. Stereotactic radiation therapy may be able to send x-rays directly to the tumor and cause less damage to normal tissue.

Detailed Description
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PRIMARY OBJECTIVES: I. To evaluate feasibility and safety of stereotactic body radiation therapy (SBRT) of the liver for treatment of hepatocellular carcinoma (HCC). SECONDARY OBJECTIVES: I. To evaluate radiographic local response, local control and time to local progression (TTLP) of treated lesions in HCC patients after liver SBRT. II. To evaluate overall survival (OS) and cancer specific survival (CSS) in HCC patients treated with liver SBRT. III. To evaluate explanted irradiated liver tissue (for patients who proceed to liver transplantation) to determine extent of residual tumor and extent of radiation effects within and around the irradiated field. OUTLINE: Patients undergo SBRT every other day over 2 weeks (5 fractions total) in the absence of unacceptable toxicity. After completion of study treatment, patients are followed up at 1, 3, 6, 9, and 12 months and then every 6 months for up to 2 years.

Official Title
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A Pilot Study of Stereotactic Liver Irradiation for Hepatocellular Carcinoma

Conditions
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Adult Hepatocellular Carcinoma, Advanced Adult Hepatocellular Carcinoma, Localized Non-Resectable Adult Liver Carcinoma, Recurrent Adult Liver Carcinoma

Intervention / Treatment
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* Radiation: Stereotactic Radiosurgery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Life expectancy > 3 months Eastern Cooperative Oncology Group (ECOG) performance status =< 2 HCC diagnosed by either of the following approaches: Histologic confirmation of HCC on biopsy Evidence of vascular enhancement of suspected lesion on at least two imaging techniques Evidence of vascular enhancement on a single technique if the alpha-fetoprotein (AFP) is > 200 ng/mL in the setting of cirrhosis or chronic hepatitis B/C HCC must be deemed unresectable by an experienced surgeon or patient must be medically inoperable or extra-hepatic metastases must be present (making resection an inappropriate treatment option) or patient must have declined the option of surgery after consultation with a surgeon Barcelona Clinic Liver Cancer score of B or C required (i.e., intermediate or advanced stage HCC) Prior liver resection or ablative therapy is permitted Prior transarterial chemoembolization (TACE) is permitted Patients must have recovered from the effects of previous therapy Maximal tumor size of 15 cm and > 700 cc of uninvolved liver Hemoglobin > 9.0 g/L Absolute neutrophil count >= 1.0 bil/L Platelets >= 70,000 bil/L Total bilirubin < 2 mg/dL International normalized ratio (INR) =< 1.5 or correctable with vitamin K (higher INR acceptable if patient is on Coumadin) Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 6 times upper range of normal Exclusion Criteria: Active hepatitis or encephalopathy related to liver failure Prior radiation therapy to the upper abdomen or thorax Lesions within 1 cm from the stomach Prior uncontrolled, life threatening malignancy within the previous 6 months Pregnancy is not permitted; women of child-bearing age must undergo pregnancy testing prior to enrollment Previous gastric, duodenal or variceal bleed within the past 2 months Thrombolytic therapy within 4 weeks or commencement of anticoagulant use within the past 3 months

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

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 SBRT every other day over 2 weeks (5 fractions total) in the absence of unacceptable toxicity. | Radiation: Stereotactic Radiosurgery<br>* Undergo SBRT<br>* Other names: stereotaxic radiosurgery;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Severe Treatment-related Toxicity | The percentage of patients who have severe treatment-related toxicity will be computed, along with exact 95% confidence intervals. Severe toxicity will be defined as grade 4 or 5 hepatic toxicity, thrombocytopenia, or gastrointestinal toxicity, graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 | Within 3 months of SBRT | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cancer Specific Survival (CSS) | Cancer Specific Survival (CSS) was assessed in patients who were diagnosed with HCC and treated with liver SBRT as the percentage of patients with Cause-Specific Death from HCC. Patients alive at the end of the follow-up period were censored. Competing risk analysis was performed. | Time from study entry to death from Hepatocellular Carcinoma (HCC) progression, assessed up to 2 years | 
| Overall Survival (OS) | Overall Survival, estimated using the Kaplan-Meier method, reflected the percentage of patients who were were diagnosed with HCC and started SBRT treatment and were still alive at the conclusion of the study. | Time from study entry to death from any cause, assessed up to 2 years | 
| Time to Local Progression (TTLP) of Treated Lesions | Time to Local progression (TTLP) of treated lesions in HCC patients after liver SBRT treatment was evaluated using Response Evaluation Criteria In Solid Tumors Criteria (RECIST). For patients who died from the study disease without progression of the radiated lesion, time to local progression was censored at the date of death. For patients not known to have died as of the data cut-off date, and who did not have locally progressive disease, time to local progression was censored at the last progression-free disease assessment. | From date of first treatment dose to the first date of objective local progressive disease as defined by RECIST criteria, assessed up to 2 years |