Stereotactic Body Radiation Therapy in Treating Patients With Metastatic Breast Cancer, Non-small Cell Lung Cancer, or Prostate Cancer

Study Overview
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Brief Summary
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This phase I trial studies the side effects and the best dose of stereotactic body radiation therapy in treating patients with breast cancer, non-small cell lung cancer, or prostate cancer that has spread to other parts of the body. Stereotactic body radiation therapy delivers fewer, tightly-focused, high doses of radiation therapy to all known sites of cancer in the body while minimizing radiation exposure of surrounding normal tissue.

Detailed Description
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PRIMARY OBJECTIVES: I. To determine the recommended stereotactic body radiation therapy (SBRT) dose for each of the metastatic locations being treated given the individual and overlapping fields when multiple metastases are treated with SBRT in a national clinical trials network setting. SECONDARY OBJECTIVES: I. To estimate rates of >= grade 3 Common Terminology Criteria for Adverse Events (CTCAE), version (v.) 4.0 adverse events other than a dose-limiting toxicity (DLT) which is possibly, probably, or definitely related to treatment and which occurs within 6 months from the start of SBRT to multiple metastases. II. To estimate the rates of long-term adverse events occurring up to 2 years from the end of SBRT. III. To explore the most appropriate and clinically relevant technological parameters to ensure quality and effectiveness throughout radiation therapy processes, including imaging, simulation, patient immobilization, target and critical structure definition, treatment planning, image guidance and delivery. OUTLINE: Patients undergo 3-5 fractions of image-guided stereotactic body radiation therapy to all existing metastases over 1-3 weeks with at least 40 hours between treatments for an individual metastasis. After completion of study treatment, patients are followed up at 35-45 days and then every 3 months for 2 years.

Official Title
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A Phase 1 Study of Stereotactic Body Radiotherapy (SBRT) for the Treatment of Multiple Metastases

Conditions
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Male Breast Carcinoma, Prostate Adenocarcinoma, Recurrent Breast Carcinoma, Recurrent Non-Small Cell Lung Carcinoma, Recurrent Prostate Carcinoma, Stage IV Breast Cancer, Stage IV Non-Small Cell Lung Cancer, Stage IV Prostate Cancer

Intervention / Treatment
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* Radiation: Stereotactic Body Radiation Therapy (SBRT)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Metastatic breast cancer (MBC) OR metastatic non-small cell lung cancer (NSCLC) OR metastatic adenocarcinoma of the prostate; the sites of allowed metastases are: peripheral lung, central lung, mediastinal/cervical lymph node, liver, spinal/paraspinal, osseous, and abdominal-pelvic NOTE: after the required number of evaluable patients have been accrued for a given dose level, the accrual for that metastatic location will be temporarily suspended while the safety of that dose level is assessed; a patient can only be entered onto the trial if all of their metastatic locations are open to accrual (e.g. if central lung is temporarily suspended for safety assessment and the patient has a central lung metastases, regardless of other metastases, they cannot enroll until the safety of dose to central lung is determined) Primary tumor site without progression at registration All metastases not resected must be amenable to SBRT The patient must meet ONE of the three following criteria: 3-4 radiographically distinct metastases of any distribution in the allowed anatomical sites OR 2 radiographically distinct metastases that must be anatomically close (i.e., with less than or equal to 5 cm of normal tissue between them) OR 3 or 4 distinct metastasis, 2 or 3 to be treated with SBRT and the other (s) having been surgically removed Evaluation by a radiation oncologist within 45 days prior to study registration Evaluation by a medical oncologist within 45 days prior to study registration The following imaging workup to document metastases within 45 days prior to study registration: Computed tomography (CT) scans of the chest, abdomen and pelvis with radionuclide bone scan OR whole body positron emission tomography (PET)/CT History/physical examination within 45 days prior to study registration Zubrod performance status =< 2 within 45 days prior to study registration Age >= 18 years Absolute neutrophil count (ANC) >= 500 cells/mm^3 Platelets >= 50,000 /mm^3 Hemoglobin >= 8.0 g/dl (Note: the use of transfusion or other intervention to achieve hemoglobin [Hgb] >= 8.0 g/dl is acceptable) If liver metastases present, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) must be < 3 x upper limit of normal (ULN) Patient must provide study specific informed consent prior to study entry For females of child-bearing potential, negative serum/urine pregnancy test within 14 days prior to study registration Exclusion Criteria: Progression of primary tumor site (breast, prostate, or lung) at time of registration Metastases with indistinct borders making targeting not feasible Known brain metastases Prior palliative radiotherapy to metastases Metastases located within 3 cm of the previously irradiated structures: Spinal cord previously irradiated to > 40 Gy (delivered in =< 3 Gy/fraction) Brachial plexus previously irradiated to > 50 Gy (delivered in =< 3 Gy/fraction) Small intestine, large intestine, or stomach previously irradiated to > 45 Gy (delivered in =< 3 Gy/fraction) Brain stem previously irradiated to > 50 Gy (delivered in =< 3 Gy/fraction) Whole lung previously irradiated with prior volume 20 Gy (V20Gy) > 30% (delivered in =< 3 Gy/fraction) Primary tumor irradiated with SBRT Metastasis irradiated with SBRT Severe, active co-morbidity, defined as follows: Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months prior to registration Transmural myocardial infarction within the last 6 months prior to registration Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy within 30 days prior to registration Severe hepatic disease, defined as a diagnosis of Child-Pugh class B or C hepatic disease Human immunodeficiency virus (HIV) positive with cluster of differentiation (CD) 4 count < 200 cells/microliter; note that patients who are HIV positive are eligible, provided they are under treatment with highly active antiretroviral therapy (HAART) and have a CD4 count >= 200 cells/microliter within 30 days prior to registration; note also that HIV testing is not required for eligibility for this protocol End-stage renal disease (i.e., on dialysis or dialysis has been recommended) Pregnancy or women of childbearing potential not willing/able to use medically acceptable forms of contraception during protocol treatment or for at least 6 months following treatment

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: Stereotactic Body Radiation Therapy (SBRT)<br>Patients undergo 3-5 fractions of image-guided stereotactic body radiation therapy to all existing metastases over 1-3 weeks with at least 40 hours between treatments for an individual metastasis. | Radiation: Stereotactic Body Radiation Therapy (SBRT)<br>* Undergo SBRT<br>* Other names: SBRT;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dose-limiting toxicity (DLT) scored according to the National Cancer Institute (NCI) CTCAE version 4.0 for each of 7 metastatic locations when multiple metastases are treated with SBRT | Adverse events outlined by metastatic location (full detail in protocol) reported as being probably or definitely related to protocol treatment. | Within 6 months from the start of treatment; for each of the 7 metastatic locations, analysis occurs after 6 evaluable patients have been followed for a minimum of 6 months from the start of treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of long-term adverse events, scored according to the NCI CTCAE v. 4.0 | Adverse events reported as being possibly, probably, or definitely related to protocol treatment. | Up to 2 years from end of treatment; analysis occurs after all patients have been potentially followed for 2 years from registration | 
| Rates of >= grade 3 adverse events, scored according to NCI CTCAE v. 4.0 | Adverse events (other than DLTs) reported as being possibly, probably, or definitely related to protocol treatment. | Within 6 months from the start of treatment; analysis occurs after all patients have been followed for a minimum of 6 months from the start of treatment |