Vertebral Marrow Attention Trial (VMAT)

The University of Texas System (UT)

Status: Completed

Conditions: Lung Cancer

Treatments: Other: Evidence-based radiation dose limitation to the vertebral bone marrow

Study type: Interventional

Funder types: Other

Identifiers

NCT05248256

HSC20210892H (Other Identifier)

CTMS# 21-0168

Details and patient eligibility

About

The purpose of this study is to see whether designing radiation to spare the vertebral bone marrow can limit the rates of lymphopenia during standard of care chemoradiation therapy and in the time to count recovery in the ensuing weeks. Secondary endpoints will examine whether this leads to improved disease control whether this is predictive of improved clinical outcomes such as rates of local recurrence (LR), metastasis free survival (MFS), overall survival (OS), and progression free survival (PFS) which will be followed prospectively up to 5 years.

Enrollment: 12 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adult patient > 18 years
• Patients with AJCC (American Joint Committee on Cancer) 8 T1-T4, N1-N3, M0 stage IIIA-IIIC NSCLC (non small cell lung cancer)
• Patients with oligometastatic disease stage IV, M1 disease, in which definitive concurrent chemoradiotherapy to the thorax is planned
• CBC/CMP within these limits
• Absolute lymphocyte count>500/ml
• Hemoglobin>8 g/dL
• AST (aspartate aminotransferase)/ALT (alanine transaminase) <2.5 times of ULN
• Eastern Cooperative Oncology Group (ECOG) 0-2

Exclusion criteria

• History of thoracic irradiation
• History of palliative radiation for the current malignancy under consideration
• Patients not being treated with definitive standard of care to the chest
• History of bone marrow disease and or leukemia
• History of prior cytotoxic chemotherapy for a disease other than for the current malignancy
• Polymetastatic disease, defined here as ≥3 or more extrathoracic metastases
• Administration of concurrent immunotherapy during radiation therapy, either as part of another clinical trial or otherwise

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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12 participants in 1 patient group

Radiation Dose Limitations to VMAT

Experimental group

Description:

Patients confirmed to have T1-T3 N1-N3 (Stage IIIA-IIIC) or select Stage IV primary adeno- or squamous cell-carcinoma of the lung will be treated per standard of care; concurrent chemoradiotherapy for 6 to 6.5 weeks, followed by consolidative immunotherapy. A CT simulation scan is obtained with the patient in the treatment position allowing the radiation oncologist to delineate intended tumor targets and organs at risk (OAR). Using specialized treatment planning software, a radiation plan is generated with the goal of maximizing tumor coverage with intended prescription dose and minimizing unintended radiation dose to OARs below established thresholds. The primary intervention of this trial will be sparing the thoracic bone marrow. This will be done by delineating the thoracic bone marrow on the CT simulation scan and applying vertebral marrow-specific OAR constraints during treatment planning to optimally spare radiation dose to this structure during treatment

Treatment:

Other: Evidence-based radiation dose limitation to the vertebral bone marrow