RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. This may be an effective treatment for liver cancer. PURPOSE: This phase I/II trial is studying the side effects and best dose of external-beam radiation therapy in treating patients with liver cancer that cannot be removed by surgery.
OBJECTIVES: * To assess the feasibility and safety of radiotherapy (RT) in patients with hepatocellular carcinoma. (Phase I) * To assess the safety and efficacy of RT in these patients. (Phase II) * To generate reproducible peptide patterns of the serum proteome or specific serum sub proteomes in these patients. * To assess changes in the proteome or sub proteome patterns after RT in these patients. * To detect peptides that discriminate between before and after RT in these patients. * To identify these discriminating peptides in these patients. OUTLINE: This is a multicenter, phase I dose-escalation study followed by a phase II study. Patients undergo radiotherapy (RT) once daily, five days a week, for 6 weeks. Intensity-modulated, 3-dimensional conformal, or fractionated stereotactic RT may be used. After completion of study therapy, patients in the phase I portion are followed for 1 year and patients in the phase II portion are followed for 3 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
18
Once daily RT sessions with 2 Gy, five days a week (on weekdays), will be performed. Phase I: Dose finding according to the following escalation table: Dose level Radiotherapy dose (1 x 2 Gy session/day, 5 sessions/week) 1. (3 patients) 27 x 2 Gy = 54 Gy 2. (3 patients) 29 x 2 Gy = 58 Gy, with optional field reduction after a dose of 54 Gy 3. (3 patients) 31 x 2 Gy = 62 Gy, with optional field reduction after a dose of 54 Gy 4. (5 patients) 33 x 2 Gy = 66 Gy, with optional field reduction after a dose of 54 Gy 5. (5 patients) 35 x 2 Gy = 70 Gy, with optional field reduction after a dose of 54 Gy Phase II: The dose for phase II will be recommended according to the MTD determined in phase I, if the MTD is 62 Gy or higher. If the MTD is 58 Gy or lower, the phase II part of the trial will not be performed.
Once daily RT sessions with 2 Gy, five days a week (on weekdays), will be performed. Phase I: Dose finding according to the following escalation table: Dose level Radiotherapy dose (1 x 2 Gy session/day, 5 sessions/week) 1. (3 patients) 27 x 2 Gy = 54 Gy 2. (3 patients) 29 x 2 Gy = 58 Gy, with optional field reduction after a dose of 54 Gy 3. (3 patients) 31 x 2 Gy = 62 Gy, with optional field reduction after a dose of 54 Gy 4. (5 patients) 33 x 2 Gy = 66 Gy, with optional field reduction after a dose of 54 Gy 5. (5 patients) 35 x 2 Gy = 70 Gy, with optional field reduction after a dose of 54 Gy Phase II: The dose for phase II will be recommended according to the MTD determined in phase I, if the MTD is 62 Gy or higher. If the MTD is 58 Gy or lower, the phase II part of the trial will not be performed.
Maastro Lab at University of Maastricht
Maastricht, Netherlands
Kantonsspital Aarau
Aarau, Switzerland
Universitaetsspital-Basel
Basel, Switzerland
Istituto Oncologico della Svizzera Italiana - Ospedale San Giovanni
Bellinzona, Switzerland
Dose-limiting toxicity (Phase I)
Time frame: during RT or within 30 days after the last RT dose, is a DLT.
Best objective response of target liver lesions (TLLs)
Time frame: according to RECIST criteria for up to 1 year after completion of study therapy (Phase II)
Best objective response of TLLs according to RECIST criteria (Phase I)
Time frame: according to RECIST criteria (Phase I)
Adverse events according to NCI CTCAE v.3.0
Time frame: during therapy and within 3 months after completion of study therapy (Phases I and II)
Volumetric response of TLLs
Time frame: at 5 months after completion of study therapy (Phase II)
Time to progression of TLLs (Phase II)
Time frame: calculated from registration until documented tumor progression of target liver lesions.
Duration of response of TLLs (Phase II)
Time frame: the time from achieving an objective response (CR + PR) to a progression of target liver lesions according to RECIST or death.
Stable disease of TLLs (Phase II)
Time frame: will be determined according to RECIST
Time to liver event (Phase II)
Time frame: from registration until progressive liver disease.
Progression-free survival (Phase II)
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Once daily RT sessions with 2 Gy, five days a week (on weekdays), will be performed. Phase I: Dose finding according to the following escalation table: Dose level Radiotherapy dose (1 x 2 Gy session/day, 5 sessions/week) 1. (3 patients) 27 x 2 Gy = 54 Gy 2. (3 patients) 29 x 2 Gy = 58 Gy, with optional field reduction after a dose of 54 Gy 3. (3 patients) 31 x 2 Gy = 62 Gy, with optional field reduction after a dose of 54 Gy 4. (5 patients) 33 x 2 Gy = 66 Gy, with optional field reduction after a dose of 54 Gy 5. (5 patients) 35 x 2 Gy = 70 Gy, with optional field reduction after a dose of 54 Gy Phase II: The dose for phase II will be recommended according to the MTD determined in phase I, if the MTD is 62 Gy or higher. If the MTD is 58 Gy or lower, the phase II part of the trial will not be performed.
Inselspital Bern
Bern, Switzerland
Kantonsspital - St. Gallen
Sankt Gallen, Switzerland
Time frame: calculated from registration until documented tumor progression or death, whichever occurs first.
Overall survival (Phase II)
Time frame: calculated from registration until death
Compensatory liver tissue hypertrophy at baseline and at 5 months after completion of study therapy (Phase II)
Time frame: Increase in residual liver volume (= total liver - GTV) (ml) between registration and 5 months after RT will be calculated
Child-Pugh Score
Time frame: at last study visit and at 1, 2, 3, and 5 months after completion of study therapy (Phase II)
Serum alpha-fetoprotein level (Phase II)
Time frame: will be measured until progression, if AFP is ≥ 1.5 x ULN at baseline.