Neoplasms

Digestive System Diseases

All Conditions

Rectal Neoplasms

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Intestinal Diseases

Rectal Diseases

Antineoplastic Agents

All Drugs and Chemicals

Oxaliplatin

Capecitabine

Antimetabolites

A VMAT-SIB technique was used. Radiation dose prescribed to PTV2 was 45 Gy (1.8 Gy/fraction), five sessions weekly in 25 daily fractions. A simultaneous boost was delivered on PTV1 with a total dose of 57.5 Gy (2.3 Gy/fraction). Dose-volume histograms (DVHs) were calculated for the PTV1, PTV2 and Organs at risks.

The prescribed concurrent chemotherapy consisted of oxaliplatin infusion 130 mg/m2 on days 1, 17, 35 and capecitabine 1650 mg/m2 daily (825 mg/m² twice daily, 5 days/week) over all the treatment.

Radiation dose prescribed to PTV2 was 45 Gy (1.8 Gy/fraction), five sessions weekly in 25 daily fractions. A simultaneous boost was delivered on PTV1 with a total dose of 57.5 Gy (2.3 Gy/fraction). Dose-volume histograms (DVHs) were calculated for the PTV1, PTV2 and OARs. Patients were treated only if the relative variations of the bone markers between the images were within 3 mm along the three spatial directions. Planning and delivery processes underwent to systematic independent-check procedures.

VMAT-SIB

The prescribed concurrent chemotherapy consisted of oxaliplatin infusion 130 mg/m2 on days 1, 17, 35 and capecitabine 1650 mg/m2 daily (825 mg/m² twice daily, 5 days/week) over all the treatment. An adequate blood count was necessary to start each chemotherapy infusion. Adjuvant chemotherapy was recommended on patients with high risk factors at pathological examination and decision was left to medical oncologists discretion.

XELOX

Alessio G Morganti, Professor

This was a prospective phase II study on patients with locally advanced rectal cancer or local recurrence, to evaluate the pathological response and resectability of a neoadjuvant treatment based on the use of a combined treatment with VMAT-SIB and two drugs chemotherapy ( XELOX).

This was a prospective phase II study on patients with LARC or local recurrence, to evaluate the pathological response and resectability of a neoadjuvant treatment based on the use of a combined treatment with VMAT-SIB and two drugs chemotherapy ( XELOX).

The primary aim was to asses the pathological response rate. Key secondary aim was the acute toxicity. Secondary aims were local control, disease-free survival (DFS) and overall survival (OS).

The follow-up period of each subjects started at the end of combined treatment and concluded after a period of maximum 60 months or until death.

Preoperative Chemoradiation With VMAT-SIB in Rectal Cancer

Preoperative Chemoradiation With VMAT-SIB in Rectal Cancer: a Phase II Study.

Pathological response was determined according to the TNM classification system of the American Joint Committee on Cancer. The complete resection of the tumor (R) with no histological proven residual disease in the surgical specimen, was defined as pathological complete response (pCR =pT0). Near complete response (pTmic) was defined as the presence of a number of neoplastic cells inferior to 10%.

To score acute toxicity CTCAE v.3.0 was used

IRCCS Azienda Ospedaliero-Universitaria di Bologna

Associate professor of Gastroenterology

Symptoms and General Pathology

Neoplasm Metastasis

Neoplastic Processes

Planning according to local protocols. No more than 2 fields; no beam modifying devices, other than multileaf collimators (MLCs). Alternate weighting of beams allowed (ie. 1:2 AP:PA). Review of dosimetry not required, if performed as per institutional standard.

Minimum of kV image matching on unit daily.

Contouring: GTV based on available imaging (CT sim scan alone-no special imaging), expect to be between 1.5cm and 20cm clinically or from imaging. CTV-optional in all scenarios. If using CTV=GTV +0.5 to 0.7cm adjust to anatomy as follows:

* If only bone involved: recommend not to expand past bone; but a 0.5-0.7cm CTV expansion outside of bone into muscle or soft tissue is allowed at RO discretion
* If bone and soft tissue involved: 0.5 to 0.7cm CTV expansion is optional, allowed at RO discretion
* If spinal metastases: CTV is optional. If used can include whole vertebral body at RO discretion PTV=CTV or GTV+(1 to 1.5)cm at RO discretion. PTV_eval=PTV cropped 0.5cm below skin. OARs: max 2 OARs permitted for VMAT arm. OAR constraints are at RO discretion. If lung/kidneys are within 5cm of PTV, absence of constraints for contours should be noted in treatment plans or dose constraint sheet prior to planning. PTV can be compromised for OAR at RO's discretion. Kidneys considered 1 organ

simple unplanned palliative radiotherapy-(either 8 Gy in 1 fraction or 20 Gy in 5 fractions), chosen pre-randomization at ROs or centres discretion

SUPR

volumetric modulated arc therapy--(either 8 Gy in 1 fraction or 20 Gy in 5 fractions), chosen pre-randomization at ROs or centres discretion

VMAT

Hadassah Abraham

Robert A Olson, MD

Robert A Olson

Shilo Lefresne, MD

Joanna Laba, MD

Barbara-Ann Millar, MD

Rob Olson, MD

The primary objective is to patient-reported Quality of Life related to complete control of Radiation Induced Nausea and Vomiting (RINV) between standard palliative radiotherapy and VMAT. Secondarily, we will assess rate of complete control of RINV. However, the investigators hypothesize that there will be no difference in pain response between the two arms, because they are receiving the same dose.

For this study, SUPR (simple unplanned palliative radiotherapy) refers to the delivery of radiation to the treatment area with a simple technique, either two opposed fields (parallel opposed pair), or a single direct field. The entire portal is exposed to the specified dose and therefore does not spare normal tissue. This technique requires minimal calculation, and typically the dose distribution is not reviewed by the radiation oncologist or medical physics.

In general, the adverse event profile of RT is associated with irradiation of normal tissue within the treatment field. With the dose prescribed in this study, the probability of serious adverse effects is exceedingly low. However, fatigue, soreness, pain flare, and skin-redness in the irradiated area are relatively common adverse events. In addition, site-specific toxicity could occur, including esophagitis, nausea, or diarrhea when there is dose delivered to the GI tract. Avoiding this toxicity is a motivating factor for the study.

In order to deliver 3D Conformal Radiotherapy, a computerized tomography (CT) simulation is used to develop the treatment plan. The goal is to deliver a conformal radiation dose to the target volume with maximal sparing of the normal tissue. VMAT (Volumetric Modulated Arc Therapy) is a type of 3D conformal RT, and delivers the radiation dose more conformally than SUPR, possibly reducing acute and late toxicity. The disadvantages of VMAT include more complex planning and quality assurance processes compared with SUPR. The complex planning required can be time-consuming, which can have a significant impact on departmental resources, and the wait time for the patient.

Bone metastases are the most common site of distant metastases and can cause severe and disabling effects, including pain, spinal cord compression and pathologic fracture. These complications can greatly affect a patient's quality of life and cause immense suffering.

Radiotherapy (RT) is an effective treatment for palliative patients with painful bone metastases. It is also efficacious in preserving function and maintaining skeletal integrity, while minimizing the occurrence of adverse skeletal related events. There is a significant amount of evidence showing that a single fraction (SF) of RT provides equivalent pain relief as multiple fractions (MF), which are associated with more acute toxicity, are less convenient for patients and costlier for the health care system. Therefore, single fraction radiation therapy (SFRT) is encouraged, but 20 Gy in 5 fractions is also allowed in this study, though should be chosen only in patients with a complicated bone metastases by fracture, neurological deficit (e.g. spinal cord compression), or a large soft tissue component. In patients with advanced disease, management strategies focus on improving quality of life (QOL), rather than conventional endpoints such as survival.

Currently, the standard of care in British Columbia for palliative patients with bone metastases is SUPR. In other jurisdictions, however, factors such as physician remuneration make other complex planning techniques more popular.

BC Cancer is publicly funded with no direct costs to patients. All RT in the province is provided by 6 centres where radiation oncologists receive an annual salary, which are independent of RT treatment technique and duration. Due to the lack of financial incentive associated with a more complex RT plan, BC Cancer is a unique clinical setting to assess the use of VMAT versus SUPR.

As facilities providing RT have gained more experience with VMAT and improvements to VMAT planning software have been made, the planning time required has been reduced. Previously, approximately 2 weeks was required for a team at the BC Cancer to create a VMAT plan for a palliative patient with bone metastases; however, we hypothesize this can now be reduced to three days in settings with low dose prescription.

This study will allow the investigators to determine if there is reduced toxicity associated with VMAT compared to SUPR with only a modest impact on resources. The investigators hypothesis is that VMAT will have reduced toxicity compared with SUPR for palliative patients with bone metastases. The investigators also hypothesize that there will be no difference between the two arms in terms of pain response, due to the fact that the doses are equal. This hypothesis is driven by the radiobiologic rationale, which defines effective RT as the ability of radiation to induce tumour cell death while sparing normal cells.

The importance in determining if there is any benefit in terms of toxicity with VMAT compared with SUPR for palliative patients with bone metastases is obvious when consequences related to its adoption are considered. As previously discussed, although the planning time has been drastically reduced, there is still an expected modest increase in resources required to carry out a VMAT plan. For patients, the pre-treatment process of VMAT is more burdensome, i.e. patients have to wait longer before receiving VMAT as compared to SUPR, due to the increased plan complexity. Therefore, it is important to consider the patient experience in relation to the RT administration.

In summary, evidence that either supports or refutes the hypothesis that VMAT will have reduced toxicity compared with SUPR for patients with bone metastases will be helpful in guiding future practices. We are not aware of any other randomized control trials (completed or ongoing) that have addressed this issue, though a London Ontario study is randomizing patients receiving palliative lung RT to SUPR vs VMAT. Due to the implications of VMAT on departmental resources and patient experience, better evidence from a randomized control trial is required before the widespread use of this technique can be justified.

Simple randomization with stratification will be used to randomly assign patients to either Arm 1 or Arm 2 in a 1:1 ratio using a computer-generated randomization scheme.

SUPR-3D: Simple Unplanned Palliative Radiotherapy Versus 3D Conformal Radiotherapy for Patients With Bone Metastases

SUPR-3D: A Randomized Phase III Trial Comparing Simple Unplanned Palliative Radiotherapy Versus 3D Conformal Radiotherapy for Patients With Bone Metastases

RINV as measured by the Functional Living Index - Emesis (FLIE) at day 5 post RT start

as measured by a daily patient diary (day 1-5)

British Columbia Cancer Agency

Radiation Oncologist & Department Head Radiation Oncology & Developmental Radiotherapeutics

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Prostatic Neoplasms

Adenocarcinoma

Carcinoma

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Central Nervous System Depressants

Anesthetics

Anesthetics, Local

insertion of 3 fiducial markers, prostate will receive 78 Gy with dose escalation to prostate focal lesion up to 87 Gy

For each patient the radio-opaque marker (used for treatment verification) will be inserted by ultrasound guidance \& local anaesthetic with an 17ga x 30cm brachytherapy needle that has 1.2mm x 3mm one gold marker. The ultrasound probe (as used for transrectal biopsy) will be introduced rectally with the patient in the left lateral position. After measuring the volume of the prostate and determining the desired position (preferably in the corpus of prostate), three gold markers will be inserted as follows: one into right side, one into left side of the base and the third in the apex of the prostate

Dose escalation to prostate focal lesion

Gold markers implanted in the prostate are used frequently for position verification of the prostate during external-beam radiotherapy. By using the markers as a surrogate for the prostate itself, not only set-up errors, but also the internal motion of the prostate relative to the bony anatomy can be identified.

It is thus believed that escalated dose marker guided radiotherapy should result in better biochemical control compared to conventional external beam radiotherapy, with a similar or lower incidence of toxicity. However, clinical data to support this is still limited. The purpose of this study is to directly compare late toxicity as well as biochemical control between patients treated with dose escalated marker guided radiotherapy versus conventional dose non-marker guided radiotherapy who has otherwise been treated with similar radiotherapy planning techniques and equipment.

Prostate magnetic resonance imaging has undergone several technical improvements and shows promises for prostate tumor detection and localization. In addition to morphological information, magnetic resonance imaging allows an estimation of physiological properties of tissues. Diffusion-weighted magnetic resonance imaging is sensitive to restriction of diffusion of water molecules, and dynamic contrast enhanced magnetic resonance imaging can analyze tissue micro vascular properties. Multi para metric magnetic resonance imaging combining Diffusion-weighted and Dynamic contrast enhanced has demonstrated its value in distinguishing malignant from benign prostate tissue.

Higher radiation dose levels were consistently associated with improved biochemical control outcomes and reduction in distant metastases. Radiation dose was one of the important predictors of long-term biochemical tumor control. Dose levels \< 70.2 Grey and 70.2-79.2 Grey were associated with 2.3 and 1.3-fold increased risks of pro static specific antigen relapse compared with higher doses. However, further dose escalation to the whole gland is limited due to an unacceptable high risk of acute and late toxicity. Moreover, local recurrences often originate at the location of the macroscopic tumor, so boosting the radiation dose at the macroscopic tumor within the prostate might increase local control. A reduction of distant metastases and improved survival can be expected by reducing local failure. Treating the dominant focus or boosting the dose to this area while reducing the dose to as much healthy tissue as possible has significant potential for improving treatment.

Thirty consecuative loclized prostate cancer patients will be recruited according to inclusion \& exclusion criteria. Once the patient meets the selection criteria stratification will be done according to the following risk group classification:

Stage Gleason score PSA Low risk T1-T2a 2-6 \< 10 ng/mL Intermediate risk T2b-T2c 7 10-20 ng/mL High risk T3a 8-10 \> 20 ng/mL

The patient will receive 2-6 months of neo adjuvant hormonal treatment, followed with concomitant hormonal treatment during the radiation course for intermediate and high risk groups then adjuvant hormonal for 2-3 years in the high risk group.

For each patient the radio-opaque marker (used for treatment verification) will be inserted by ultrasound guidance \& local anesthetic with an 17 GA x 30 cm brachy therapy needle that has 1.2 mm x 3 mm one gold marker. The ultrasound probe (as used for trans rectal biopsy) will be introduced rectally with the patient in the left lateral position. After measuring the volume of the prostate and determining the desired position (preferably in the corpus of prostate), three gold markers will be inserted as follows: one into right side, one into left side of the base and the third in the apex of the prostate. All patients will receive a course of preventive antibiotic treatment that consists of ciprofloxacine 500 mg BID, 1 day before implantation and 4 consecutive days. Patients under anti-platelet therapy will be told to stop the medication 5 days before implantation.

CT images will be done within 5 days of markers insertion in the same treatment supine position with Knee \& ankle support. CT images will be taken in 1.25 mm slice thickness from the top of the 4th lumbar vertebrae to ischial tuberosities. Patients will be asked to evacuate bowels prior to scanning, and bladder will be kept comfortably full by drinking two glasses of water (250-500 ml) 30 min prior to the scan.

The reference marks, one mid line and two lateral, will be placed at the level of the upper border of the symphysis pubis or iliac crest. No contrast will be used so as to avoid the dose artifact by it during treatment planning and dose calculation.

Multi parametric magnetic resonance imaging combing Diffusion-weighted \& Dynamic contrast enhanced with intravenous contrast will be done prior to Marker insertion with the sequence of: axial T1 \& T2, coronal T2 \& spare, post contrast dynamic axial \& sagittal and diffusion with ADC. The views of MRI images will be in 1.25 mm thickness with 0 gap. Fusion of both CT images \& MRI images will be done using manual registration guided by bony landmarks.

Delineation of clinical target volumes \& risk organs will be done on CT images guided with MRI fused images according to Radiation therapy oncology group criteria. MRI T2 weighted images will guide the pro static delineation from base to apex, with more accurate identification of the apex compared to CT. Also Diffusion-weighted with Dynamic contrast enhanced magnetic resonant imaging will be of value for identification of dominant focal lesion of the prostate.

The patient will be treated with radical radiotherapy to prostate 78 Gray/35# (2.2 Gray/#) with simultaneous integrated boost to focal lesion 87.5 Grey/35# (2.5 Gray/#). Lymph node 60 Grey if positively involved. Seminal vesicle will receive 78 Gray if involved \& 54 Gray if not. Roche formula will be used to estimate lymph node \& seminal vesicle involvement if more than 15%:

* Seminal vesicle involvement (%) = PSA + \[10× (Gleason-6)\]
* Pelvic lymph node involvement = 2/3 × PSA + \[10× (Gleason score -6)\]

Constrains for organs at risk will be followed according to QUANTEC. Plan acceptance for Planning target volume of the targets will be done as follows:

* D 95(95% of the prescribed dose) must be received by at least 95% of the planning target volume.
* D max (dose received by 2% of the volume) should not exceed 107% and should be inside the clinical target volume.
* D min (dose received by 98% of the volume) should not be less than 90% and should be outside the clinical target volume.

In addition to the standard quality assurance procedures carried out for any radiation technique, such as dose output calibration, ISO-center and Multi-leaf collimator verification, V MAT patients will undergo specific pretreatment quality assurance measures to check ISO-center absolute dose (using ionization chamber and slap phantom) and dose (using portal image and portal dosimeter module on the planning system).

Position verification will be done guided with implanted gold markers with daily portal imaging (AP \& lateral) correction protocol in mediolateral, superior-inferior \& inward-outward directions. The portal correction images will be verified daily to detect average shifts in the three directions using 2D-2D match \& Marker Match. Random or inter-fraction errors which are deviations between different fractions will be taken weekly during a treatment series. Systematic errors Which are deviations between the planned patient position and the average patient position of a course of fractional therapy will be taken in the first three settings. The mean and standard deviation (SD) of the systematic error and SD of random errors will be analyzed. To represent true magnitude of errors, the absolute value of the deviations will be also considered. These means will be used in calculations of the off-line treated Dose-Volume Histogram versus Planned Dose-Volume Histogram and in measurement of systemic \& random error to define reasonable planning target volume.

Follow up of the patients will be done with mean of 12 months to detect biochemical control \& disease free survival. PSA \& pelvic ultrasound will be done every 3 months for first 2 years then every 6 months for 3-5 years. Genito-urinary, gastro-intestinal \& hematological toxicity will be assessed using Radiation Therapy Oncology Group toxicity score \& patient reported out coming will be assessed using questionnaire (validated Arabic translation) every 3 months.

VMAT dose escalation protocol with image guided fiducial markers

Dose Escalation Using Fiducial Markers in Image Guided Volumetric Modulated Arc Therapy to the Focal Lesion Micro Boost of Localized Prostate Cancer

The Impact of Dose Escalation Using Gold Markers in Image Guided Volumetric Modulated Arc Radiotherapy to the Focal Lesion Micro Boost of Localized Prostate Cancer

Position verification will be done guided with implanted gold markers with daily portal imaging (AP \& lateral) correction protocol in mediolateral, superior-inferior \& inward-outward directions by mm for 35 fraction. The off-line portal pre-correction images will be verified daily to detect average shifts in the three diresctions. Random or inter-fraction errors which are deviations between different fractions will be taken weekly during a treatment series. Systematic errors Which are deviations between the planned patient position and the average patient position of a course of fractioned therapy will be taken in the first three settings. The mean and standard deviation (SD) of the systematic error and SD of random errors will be analyzed.

Follow up of the patients will be done every 3 months up to 12 months to detect biochemical control by PSA measuring. PSA \& pelvic ultrasound.

Genito-urinary \& gastro-intestinal will be assessed using RTOG toxicity score weekly during radiotherapy sessions.

Patient reported out coming will be assessed using FACIT questionnaire (validated Arabic translation) every 3 months up to 12 months.

Kasr El Aini Hospital

assistant Lecturer of Clinical Oncology

Mouth and Tooth Diseases

Ear, Nose, and Throat Diseases

Rare Diseases

Nasopharyngeal Carcinoma

Nasopharyngeal Neoplasms

Pharyngeal Neoplasms

Otorhinolaryngologic Neoplasms

Head and Neck Neoplasms

Nasopharyngeal Diseases

Pharyngeal Diseases

Stomatognathic Diseases

Otorhinolaryngologic Diseases

Nimotuzumab

Antineoplastic Agents, Immunological

Patients receive Nimotuzumab weekly during radiotherapy .

Nimotuzumab 200mg/m2 IV on d1 of a week before radiotherapy , and 100mg/m2 IV on d1 weekly for 7 cycles

Intensity-modulated radiotherapy was given to the patients with regimen of 69.96 Gy-73.92 Gy to the gross target volume of nasopharynx,69.96 Gy to the gross target volume of positive nodes, 60.06 Gy the high risk clinical target volume, 50.96 Gy to the low risk clinical target volume.

ye zhang, MD

Junlin Yi, M.D

Ye Zhang

Ye Zhang, professor

To evaluate the efficacy and toxicity of Nimotuzumab combined with VMAT in the treatment of elderly patients with nasopharyngeal carcinoma (\> 70 years old), and to provide high-level clinical evidence for the optimal treatment of elderly patients with nasopharyngeal carcinoma.

The incidence of elderly patients with nasopharyngeal carcinoma is increasing with a rapidly ageing population. However, the prognosis is worse than that of young patients. Some patients can benefit from intensive treatment such as concurrent chemoradiotherapy, but are always with obvious toxicity. With the advancement of radiotherapy technology and the emergence of molecular targeted drugs, radiotherapy combined with Nimotuzumab has shown good therapeutic efficacy and tolerance. The investigators plan to testify VMAT combined with Nimotuzumab in elderly patients with nasopharyngeal carcinoma.

Nimotuzumab Combined With VMAT in Elderly Patients With Nasopharyngeal Carcinoma

Phase II Trial of Nimotuzumab Combined With Volumetric Modulated Arc Therapy in Elderly Patients With Nasopharyngeal Carcinoma

Complete remission rate will be measured by RECIST 1.1

Acute toxicity will be measured by CTCAE4.0

late toxicity will be measured by CTCAE4.0

Chinese Academy of Medical Sciences

Chief physician

Genital Neoplasms, Male

Urogenital Neoplasms

Genital Diseases

Genital Diseases, Male

Urogenital Diseases

Prostatic Diseases

Male Urogenital Diseases

During Stage 1: Optimise nodal treatment margin, Combined real-time use of 'Multi-Leaf Collimator Adaptation' and 'kV Intrafraction Monitoring' will be used to reshape the radiation beam in real-time. The nodal target position stability will be evaluated by the cone beam computed tomography (CBCT) imaging before and after each treatment session for the first 10 patients.

During Stage 2: Use treatment margin, Combined real-time use of 'Multi-Leaf Collimator Adaptation' and 'kV Intrafraction Monitoring' will be used to reshape the radiation beam in real-time. At the same time, multi-leaf collimator (MLC) tracking will be used to reshape the radiation beam in real-time using the margin size determined in Stage 1.

This intervention uses the simultaneous combined use of two technologies: 'Multi-Leaf Collimator Adaptation' and 'kV Intrafraction Monitoring'. kV Intrafraction Monitoring (KIM) measures the motion of tissues targeted for radiotherapy in real time using kV imaging.The multi-leaf collimator (MLC) reshapes the radiation beam to maximise dose to the target tissue and minimise dose to the surrounding healthy tissue. Combining KIM and MLC allows the shaped radiation beam to follow the moving target (the prostate) while remaining fixed on a stationary target (lymph nodes) that are also being treated at the same time.

Combined real-time use of 'Multi-Leaf Collimator Adaptation' and 'kV Intrafraction Monitoring'

Thomas Eade, MBBS, RANZCR

Assessing the feasibility of implementing real-time multi-leaf collimator (MLC) tracking to account for the relative motion of the moving prostate tumour target and the static pelvic nodal target for high-risk prostate cancer patients. The capability of tracking for the relative motion of multiple targets will ensure that all the treatment targets receive correct dose as prescribed by the doctor and minimise side effects to the critical organs.

This study will assess the feasibility of implementing real-time multi-leaf collimator (MLC) tracking to account for the relative motion of the moving prostate tumour target and the static pelvic nodal target for high-risk prostate cancer patients. The capability of tracking for the relative motion of multiple targets will ensure that all the treatment targets receive correct dose as prescribed by the doctor and minimising side effects to the critical organs.

During radiation treatment, the prostate position will be monitored in real time using the KIM technology. The nodal target will be imaged before and after each treatment to evaluate the nodal treatment margin. The MLC tracking is implemented by recalculating the radiation beam shape fit for the moved prostate and static nodal targets and sending the adjusted MLC leaf positions to the treatment delivery system. The actually delivered dose to the patient will be calculated after the treatment and compared to the dose without MLC tracking to assess the treatment efficacy.

All patients receive the intervention for comparison against retrospective matched cohort.

Multi-target Tracking in Prostate Radiotherapy Using MLC and KIM

Phase I Feasibility Study of Accounting for Relative Motion of Multiple Targets in Prostate Cancer Radiotherapy Using Realtime Multi-leaf Collimator Adaptation and Kilovoltage (kV) Intrafraction Monitoring

Share for research purposes with interested parties.

The percentage of fractions delivered without software or mechanical failure

The geometric accuracy of the beam shape, determined by comparing the ideal beam shape with the actual beam shape.

Prostate motion trajectory measured by KIM.

The estimated dose distributions will be compared to the original plan using the dose reconstruction method18 based on the prostate motion trajectory and the logged MLC positions (beam shapes).

Royal North Shore Hospital

Head of Research

Acute Graft Versus Host Disease

patients with gynecological cancer treated with adjuvant conventional radiotherapy

Patients with gynecological cancer treated with adjuvant VMAT radiotherapy

VMAT therapy focuses on reducing the dose radiation in adjacent organs at risk

Volumetric modulated arc therapy

conventional radiotherapy

This is a randomized, controlled, open-label, prospective and longitudinal clinical trial. Rectal, intestinal and bladder EBRT-related toxicity will be assessed according to RTOG / EORTC scales at the first day of EBRT, during the 2nd, 3rd and 4th week of treatment, and 1, 3 and 6 months after the end of radiation treatment. The assessment of quality of life (QoL) will be measured by completing the questionnaire of the European Organization for Research and the Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ-C30) version 3.0, in addition to specific QoL questionnaires for cervical and endometrial cancer respectively (EORTC QLQ-CX 24 and EORTC QLQ-EN24), previously validated in Mexican Spanish-speaking population, and which will be simultaneously applied with the RTOG / EORTC toxicity scales.

EXPECTED RESULTS AND PERSPECTIVES:

This trial aims to provide information about the feasibility of using a newer EBRT technique, as effective as conventional 3D-conformal radiation therapy (3D-CRT), but with less toxicity.

BACKGROUND:

The standard of care in gynecological malignancies with high-risk features of recurrence following surgery is adjuvant external beam radiation therapy (EBRT) in the pelvic region, with or without concurrent chemotherapy (CT). This treatment modality offers higher local control and improves overall survival. EBRT has been associated with secondary effects due to toxicity such as cystitis, enteritis and proctitis which can compromise its effectiveness, patient´s quality of life and the interruption of the treatment. Newer EBRT techniques reduce the radiation dosis in normal tissues, with less toxicity. So far, there are no records of radiation-induced toxic effects in our population. The aim of this study is to evaluate the acute toxicity associated with pelvic postoperative EBRT using conventional or VMAT (RapidArc) technique in patients with gynecological cancer.

METHODOLOGY:

This is a randomized, controlled, open-label, prospective and longitudinal clinical trial. Rectal, intestinal and bladder EBRT-related toxicity will be assessed according to RTOG / EORTC scales at the first day of EBRT, during the 2nd, 3rd and 4th week of treatment, and 1, 3 and 6 months after the end of radiation treatment. The assessment of quality of life (QoL) will be measured by completing the questionnaire of the European Organization for Research and the Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ-C30) version 3.0, in addition to specific QoL questionnaires for cervical and endometrial cancer respectively (EORTC QLQ-CX 24 and EORTC QLQ-EN24), previously validated in Mexican Spanish-speaking population, and which will be simultaneously applied with the RTOG / EORTC toxicity scales.

EXPECTED RESULTS AND PERSPECTIVES:

This trial aims to provide information about the feasibility of using a newer EBRT technique, as effective as conventional 3D-conformal radiation therapy (3D-CRT), but with less toxicity.

patients with gynecological cancer with an indication of adjuvant radiotherapy after surgical treatment.

A Trial Comparing Acute Toxicity in Patients With Gynecological Cancer Treated With VMAT

A Randomized Open-label Trial Comparing Acute Toxicity in Patients With Gynecological Cancer Treated With Adjuvant Conventional Versus VMAT Radiotherapy.

The acute toxicity will be measured, with RTOG acute radiation morbidity scoring criteria scale, this has four grades from 0 to 4, and higher values represent a worse outcome. The principal symptoms to evaluate are genitourinary and lower gastrointestinal.

measured by completing the questionnaire of the European Organization for Research and the Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ-C30) version 3.0, previously validated in Mexican Spanish-speaking population.

The QLQ-C30 is composed of both multi-item scales and single-item measures. These include five functional scales, three symptom scales, a global health status / QoL scale, and six single items..

All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level.

Thus a high score for a functional scale represents a high / healthy level of functioning, a high score for the global health status / QoL represents a high QoL, but a high score for a symptom scale / item represents a high level of symptomatology / problems.

National Institute of Cancerología

Chief of clinical trial departament

Hypofractionated dose escalated VMAT radiotherapy

measure the local control, progression free survival and overall survival

Hypofractionated dose escalated VMAT

To compare efficacy and toxicity between hypofractionated dose escalated VMAT versus conventional concurrent chemoradiation in locally advanced head and neck cancer

patients were randomized to receive either: 70Gy in 35fx in 7wks at 2Gy/fx concurrently with weekly cisplatin 40mg/m2 (Arm A) or 74Gy in 33 fractions (fx) in 6.5 weeks at 2.24Gy/fx (Arm B). Volumetric Modulated Arc Therapy (VMAT) plans were created for both treatment arms

A Study Comparing Hypofractionated Dose Escalated VMAT to Conventional CCRT in Locally Advanced Head and Neck Cancer

A Clinical Study Comparing Hypofractionated Dose Escalated VMAT to Conventional CCRT in Locally Advanced Head and Neck Cancer

The time (in months) from the end of radiotherapy to the date of first progression

The number of patients who develop radiotherapy toxicity as assessed by CTCAE protocol Version 4.0

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Preoperative Chemoradiation With VMAT-SIB in Rectal Cancer	NCT02745639	Rectal Neoplasm...	VMAT-SIB XELOX	18 Years -	IRCCS Azienda Ospedaliero-Universitaria di Bologna
SUPR-3D: Simple Unplanned Palliative Radiotherapy Versus 3D Conformal Radiotherapy for Patients With Bone Metastases	NCT03694015	Neoplasm Metast... Neoplastic Proc... Neoplasms Pathologic Proc...	SUPR VMAT	18 Years -	British Columbia Cancer Agency
Dose Escalation Using Fiducial Markers in Image Guided Volumetric Modulated Arc Therapy to the Focal Lesion Micro Boost of Localized Prostate Cancer	NCT03384199	Prostatic Adeno...	Dose escalation...	40 Years - 80 Years	Kasr El Aini Hospital
Dose Escalation Using Fiducial Markers in Image Guided Volumetric Modulated Arc Therapy to the Focal Lesion Micro Boost of Localized Prostate Cancer	NCT03384199	Prostatic Adeno...	Dose escalation...	40 Years - 80 Years	Kasr El Aini Hospital
Nimotuzumab Combined With VMAT in Elderly Patients With Nasopharyngeal Carcinoma	NCT03915132	Nasopharyngeal ...	Nimotuzumab VMAT	70 Years -	ChineseAMS
Multi-target Tracking in Prostate Radiotherapy Using MLC and KIM	NCT02588846	Prostate Cancer	Combined real-t...	18 Years -	Royal North Shore Hospital
A Trial Comparing Acute Toxicity in Patients With Gynecological Cancer Treated With VMAT	NCT03899376	Gynecologic Can...	Volumetric modu... conventional ra...	18 Years - 80 Years	National Institute of Cancerología
A Study Comparing Hypofractionated Dose Escalated VMAT to Conventional CCRT in Locally Advanced Head and Neck Cancer	NCT03699969	Locally Advance...	Hypofractionate...	18 Years - 70 Years	Cairo University

Spots Global Cancer Trial Database for vmat

Every month we try and update this database with for vmat cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Spots Global Cancer Trial Database for vmat

Every month we try and update this database with for vmat cancer trials from around the world to help patients and their families find trials that might be right for them. We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Every month we try and update this database with for vmat cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.