This study uses a novel, recently developed unconventional radiotherapy technique which consists of three high-dose fractions directed to special segments of unresectable bulky tumors.
This is a mono-centric, prospective, two-arms, feasibility study in which the investigator will enroll up to 22 patients with locally advanced or metastatic cancers with at least one bulky (≥6cm) lesion. This study uses a novel, recently developed unconventional radiotherapy technique, consisting of a short course (3 fractions) high dose partial irradiation targeting exclusively the hypoxic segment of unresectable bulky tumors while sparing the peritumoral immune microenvironment for induction of immune-mediated tumoricidal bystander and abscopal effects. The present study will explore the potential biological and physical advantages of particle-based radiotherapy to deliver a highly conformal radiation dose to the hypoxic tumor segment defined by using hypoxia-specific Copper-64-Diacetyl-bis (N4-methylthiosemicarbazone) Positron Emission Tomography-Computer Tomography (64Cu-ATSM PET-CT) and dynamic contrast enhanced Magnetic Resonance Tomography imaging. Based on tumor location, volume and risk factors related to nearby organs at risk, patients will be divided in the "high-dose" or "reduced-dose" group which will be treated with different dose-schedules according to risk factors. Additionally, radiotherapy will be administered at the precise timing, determined individually for each patient, based on the serially mapped homeostatic immune fluctuations by monitoring blood levels of the inflammatory markers. The objective is to synchronize the radiation treatment with the favorable, most reactive anti-tumor immune response phase, in order to break tumor´s immune-tolerance locally and systemically.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
13
Partial radiotherapy targeting the hypoxic tumor segment
For treatment planning as well as for follow-up radiological tumor assessment.
For treatment planning as well as for follow-up radiological tumor assessment.
EBG MedAustron GmbH
Wiener Neustadt, Lower Austria, Austria
Bystander (local) tumor response rate
Bystander (local, at the level of the partially treated bulky tumor) response rate defined as at least a 30% regression of the unirradiated tumor tissue.
Time frame: 11 months (after treatment)
Feasibility of PARTICLE-PATHY
Feasibility of patient recruitment, treatment and follow-up rates.
Time frame: 3,5 years (recruiting time + treatment time + 11 months follow-up)
Overall survival
Defined as the time from treatment until the time of death from any cause.
Time frame: 11 months (after treatment)
Time to local tumor progression
Defined as the time from treatment until the time of local disease progression.
Time frame: 11 months (after treatment)
Time to distant tumor progression
Defined as the time from treatment until the time of distant disease progression.
Time frame: 11 months (after treatment)
Abscopal (distant) tumor response rate
Defined as the proportion of metastatic patients that exhibited an abscopal effect versus the total number of metastatic patients allocated to the treatment.
Time frame: 11 months (after treatment)
Symptoms relief
Proportion of patients who will achieve a partial or complete relief at different time-points.
Time frame: 11 months (after treatment)
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For the definition of the hypoxic tumor segment in treatment planning.
For follow-up radiological tumor assessment.
Evaluation before treatment-start, during treatment and follow-up period.
Radiation related toxicity
Toxicity assessment according to NCI CTCAE v5.0
Time frame: 11 months (after treatment)
Feasibility of timing of PARTICLE-PATHY and its relation to clinical outcomes
The feasibility of PARTICLE-PATHY and to it related TIMING will be defined by the proportion of patients allocated to this treatment who received it within dosimetric constraints after being able to define the immune-cycle periodicity and to synchronize radiotherapy with it versus the total number of patients allocated to the treatment.
Time frame: Until 11 months after treatment
Bystander/abscopal response rate in relation to dose-size of Peritumoral Immune Microenvironment (PIM)
See title
Time frame: 11 months (after treatment)
Bystander/abscopal response rate in relation to Interleukin-2 and Interferon Gamma values
Two key cytokines, Interleukin-2 (IL-2) and Interferon Gamma (INFg), will be serially assessed at baseline and after each radiotherapy treatment, in order to determine their potential role in modulating the immune response in relation to the bystander/abscopal effects.
Time frame: 11 months (after treatment)