Neo-adjuvant SABR for IVC Tumor Thrombus in Newly Diagnosed RCC

  • STATUS
    Recruiting
  • End date
    Dec 30, 2022
  • participants needed
    29
  • sponsor
    University of Texas Southwestern Medical Center
Updated on 29 July 2022
cancer
tubal ligation
metastasis
kidney tumor
kidney cancer
nephrectomy

Summary

To evaluate the safety and feasibility of pre-operative SABR of RCC IVC tumor thrombus.

To evaluate the effect of pre-operative SABR in RCC IVC tumor thrombus on relapse free survival at one year.

Description

Stereotactic Ablative Radiation Therapy (SABR): 5 fractions of 8 Gy or 3 fractions of 12Gy. The concept of stereotactic radiosurgery involves tightly conforming dose of therapeutic radiation confined to a small region of the body. This results in eradication or ablation of the target tumor with sparing of surrounding normal tissues. The largest experience with stereotactic radiosurgery is for the treatment of intracranial tumors Neoadjuvant treatment of IVC-TT with SABR may decrease local recurrences and lower the likelihood of embolic complications and systemic metastasis.

Details
Condition Renal Cell Carcinoma
Treatment Stereotactic ablative radiation therapy
Clinical Study IdentifierNCT02473536
SponsorUniversity of Texas Southwestern Medical Center
Last Modified on29 July 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Radiographic evidence of renal cancer with IVC tumor thrombus
Tumor thrombus must be ≥ level II (As per Mayo classification, it would be ≥ level I [Refer to NEVES, R. and ZINCKE, H. (1987), Surgical Treatment of Renal Cancer with Vena Cava Extension. British Journal of Urology, 59: 390-395. doi:10.1111/j.1464-410X.1987.tb04832.x])
Patient eligible for SABR to the IVC tumor thrombus as decided by the treating radiation oncologist
Patient eligible for IVC tumor thrombectomy as decided by the treating urologist
Any number of metastatic disease is allowed in the Pilot phase of the trial
• For Phase II, metastatic patients will be allowed only if all sites of
metastasis has been treated either surgically or radio-surgically (If limited
sites of metastasis are present, all of which can be resected during the
nephrectomy, then the patient can be eligible)
Age ≥ 18 years
Performance status ECOG 0-2
Any serum Albumin is allowed, but ≥ 3.4 g/dL is strongly encouraged
• Serum albumin <3.4 is a significant predictor of peri-operative
mortality(12)
Any serum AST is allowed but serum AST ≤ 34 IU/L is strongly encouraged
analysis(12)
• Significant predictor of mortality in univariate but not multivariate
Women of childbearing potential and men must agree to use adequate contraception (hormonal such as birth control pills, patch or ring; Depo-Provera, Implanon or barrier method, such as condom or diaphragm used with a spermicide of birth control; abstinence) prior to study entry, for the duration of study treatment, and for 90 days following completion of radiation therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months)
1 A female of childbearing potential is any woman (regardless of sexual
Ability to understand and the willingness to sign a written informed consent
Subjects must be able to undergo either MRI or CT
orientation, marital status, having undergone a tubal ligation, or remaining
Has not undergone a hysterectomy or bilateral oophorectomy; or
celibate by choice) who meets the following criteria

Exclusion Criteria

Subjects who have had radiotherapy to a target within 3 cm of the IVC tumor thrombus
Subjects may have received any other investigational agents or chemotherapy as long as they are eligible for SABR and surgery
Subjects with brain metastases should be excluded from this clinical trial unless all the metastasis are treated surgically or radio-surgically
Subjects with a history of pulmonary embolism is excluded
Subjects with a history of pulmonary hypertension is excluded
Subjects must not be pregnant due to the potential for congenital abnormalities
Contraindication for contrast-enhanced MRI as defined by the standard operating procedures of the Department of Radiology at UT Southwestern. Briefly, these include medically unstable; cardiac pacemaker; intracranial clips, metal implants; metal in the eyes; pregnant or nursing; claustrophobia; and impairment of the renal function with estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73m2. Patients with one or more of these contraindications but eligible to undergo contrast-enhanced CT can participate in this study and will not receive an MRI
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