Effect of High Doses of Radiation on Bone Structure and Metabolism

Mass General Brigham

Status: Completed

Conditions: Malignant Bone Tumors

Treatments: Radiation: Radiation (Surgical Arm); Radiation: Radiation (Non-surgical Arm); Procedure: Malignant Tumor Surgery

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT02323295

14-208

C06CA059267 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

This study is designed to characterize the effects of high energy radiation on bone breakdown, with a specific interest in reducing the rate of sacral fractures. Although radiation is very important in managing tumors, it is related to complications such as bone fractures. In this research study, the investigators are looking to determine changes in blood markers, bone density, and bone structure following radiation and to better understand the reason for these changes.

Full description

Participants in the Surgical Arm of the study will be treated according to the schedule outlined in protocol for a combined treatment with surgery and adjuvant high dose radiotherapy. Patients in the non surgical arm of the the study will be treated according to the protocol being treated with radiotherapy alone.

Enrollment: 12 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All laboratory tests that are a part of the eligibility criteria must be completed within 14 days prior to the date of registration. Diagnostic tests that are a part of the eligibility criteria must be performed within 30 days of the date of registration. Participants must meet the following criteria on screening examination to be eligible to participate in the study:

• Study participants must have histologically confirmed primary malignant bone tumor in the sacrum for which surgery and radiation or radiation alone are planned.

• Age 18 years or older. In children under the age of 8, tetracycline derivatives have been reported to stain tooth enamel yellow color. These considerations lead us to exclude young persons under the age of 18 from the study.

• Participants must have normal organ and marrow function as defined below:

  • Total bilirubin within normal institutional limits
  • Aspartaataminotransferase (AST) (SGOT)/ Alanine-aminotransferase (ALT) (SGPT) < 2.5 X institutional upper limit of normal
  • Creatinine within normal institutional limits or creatinine clearance > 60 mL/min/1.73 m2 for subjects with creatinine levels about institutional normal limit

• The effects of tetracyclines and radiation used in computer tomography on the developing human fetus are known to be detrimental. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.

• Participants must be able to read and understand English language and have the ability to understand and the willingness to sign a written informed consent document.

Exclusion criteria

Participants who exhibit any of the following conditions at screening will not be eligible for admission into the study.

• Participants who have had surgery, chemotherapy, or radiotherapy of the sacrum prior to entering the study
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to tetracyclines.
• Pregnant or nursing
• Uncontrolled inter current illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements

Trial design

Primary purpose: Diagnostic

Allocation: Non-Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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12 participants in 2 patient groups

Non Surgical-Radiation Only

Experimental group

Description:

Non-surgical candidates receive 72 up to 77.l4 Gy of radiation depending on the histology (72 Gy for osteosarcoma and chondrosarcoma and 77.4 Gy for chordoma

Treatment:

Radiation: Radiation (Non-surgical Arm)

Malignant Tumor Surgery And Radiation

Experimental group

Description:

The standard treatment includes pre-operative radiation of 50.4 Gy, followed by a recovery period of approximately 4 to 5 weeks. Surgery involves removing the malignant tumor in the sacrum in one piece, preferably with a cuff of normal tissue around the tumor. After approximately 6 weeks of recovery, the patient is treated with another 19.8 Gy up to 27 Gy of radiation postoperatively depending on the final margin status (higher for gross residual disease). If the wound is not healed or there is another medical reason to delay adjuvant radiation, then radiation may begin later.

Treatment:

Radiation: Radiation (Surgical Arm)

Procedure: Malignant Tumor Surgery