Spatially Fractionated Radiotherapy Versus Conventional Radiotherapy in the Treatment of Soft Tissue Sarcoma

Официальное название

Spatially Fractionated Radiotherapy Versus Conventional Radiotherapy in the Treatment of Soft Tissue Sarcoma:A Multicenter，Prospective, Phase II, Randomized Controlled Trial

Обзор

This study is a multicenter, prospective, randomized controlled phase II clinical trial designed to evaluate the efficacy and safety of Spatially Fractionated Radiation Therapy (SFRT) compared to Conventional Radiation Therapy (CRT) in the treatment of soft tissue sarcoma (STS, minimum tumor diameter ≥5 cm). A total of 106 patients were enrolled and randomized in a 1:1 ratio. The primary endpoint is the objective response rate (ORR) of the target lesion at 3, 6, 9, and 12 months post-radiotherapy, assessed using RECIST 1.1 and Choi criteria. Secondary endpoints include the 1-year local control rate (LC) of the target lesion, progression-free survival (PFS), safety (per CTCAE v5.0), and quality of life (QoL, assessed by EORTC QLQ-C30). CRT is delivered at 3.0 Gy per fraction for a total of 15-20 fractions. SFRT comprises CRT at 3.0 Gy per fraction for 15-20 fractions, augmented by weekly high-dose vertices of 8-15 Gy per fraction for 3-4 fractions, aiming to enhance tumor control and potentially stimulate immune responses. This study is a multicenter, prospective, randomized controlled phase II clinical trial designed to evaluate the efficacy and safety of Spatially Fractionated Radiation Therapy (SFRT) compared to Conventional Radiation Therapy (CRT) in the treatment of soft tissue sarcoma (STS, minimum tumor diameter ≥5 cm). A total of 106 patients were enrolled and randomized in a 1:1 ratio. The primary endpoint is the objective response rate (ORR) of the target lesion at 3, 6, 9, and 12 months post-radiotherapy, assessed using RECIST 1.1 and Choi criteria. Secondary endpoints include the 1-year local control rate (LC) of the target lesion, progression-free survival (PFS), safety (per CTCAE v5.0). CRT is delivered at 3.0 Gy per fraction for a total of 15-20 fractions. SFRT comprises CRT at 3.0 Gy per fraction for 15-20 fractions, augmented by weekly high-dose vertices of 8-15 Gy per fraction for 3-4 fractions, aiming to enhance tumor control and potentially stimulate immune responses.

Подробное описание

This study is a multicenter, prospective, randomized controlled phase II clinical trial designed to systematically compare the efficacy and safety of Spatially Fractionated Radiation Therapy (SFRT) versus Conventional Radiation Therapy (CRT) in the treatment of soft tissue sarcoma (STS, minimum tumor diameter ≥5 cm). STS is a malignant tumor with low radiosensitivity, and CRT yields limited objective response rates (ORR) and local control rates (LC). The study employs Intensity-Modulated Radiation Therapy (IMRT), Intensity-Modulated Proton Therapy (IMPT), or Volumetric Modulated Arc Therapy (VMAT) techniques. CRT is administered at 3.0 Gy per fraction for a total of 15-20 fractions. SFRT builds on CRT at 3.0 Gy per fraction for 15-20 fractions, supplemented by weekly high-dose vertices of 8-15 Gy per fraction for 3-4 fractions, aiming to enhance tumor control and stimulate potential immune responses.

A total of 106 patients will be enrolled and randomized 1:1 into the SFRT and CRT arms (53 patients per arm). The primary endpoint is the ORR of the target lesion at 3, 6, 9, and 12 months post-radiotherapy, assessed using RECIST 1.1 and Choi criteria. Secondary endpoints include the 1-year LC of the target lesion, progression-free survival (PFS), safety (per CTCAE v5.0).

Eligibility criteria include patients aged 18-70 years, ECOG performance status ≤2, and an expected survival of ≥3 months, excluding those with secondary primary tumors or severe organ dysfunction. Comprehensive baseline assessments (imaging, pathology, and laboratory tests) are conducted before treatment. Toxicity is monitored weekly during treatment, with ≥grade 3 toxicities prompting treatment suspension. Efficacy evaluations are performed at 3, 6, 9, and 12 months post-radiotherapy, with follow-up scheduled every 3 months in the first year, every 6 months in the second year, and annually thereafter. Statistical analysis is based on a one-sided α=0.05 and β=0.8, anticipating an ORR of 40% for SFRT compared to 15% for CRT.

Through its multicenter design and rigorous evaluation, this study aims to validate whether SFRT can improve ORR in STS, providing scientific evidence to optimize radiotherapy strategies, enhance patient prognosis, and improve QoL. Additionally, it seeks to offer insights into the treatment of other radioresistant tumors.

This study is a multicenter, prospective, randomized controlled phase II clinical trial designed to systematically compare the efficacy and safety of Spatially Fractionated Radiation Therapy (SFRT) versus Conventional Radiation Therapy (CRT) in the treatment of soft tissue sarcoma (STS, minimum tumor diameter ≥5 cm). STS is a malignant tumor with low radiosensitivity, and CRT yields limited objective response rates (ORR) and local control rates (LC). The study employs Intensity-Modulated Radiation Therapy (IMRT), Intensity-Modulated Proton Therapy (IMPT), or Volumetric Modulated Arc Therapy (VMAT) techniques. CRT is administered at 3.0 Gy per fraction for a total of 15-20 fractions. SFRT builds on CRT at 3.0 Gy per fraction for 15-20 fractions, supplemented by weekly high-dose vertices of 8-15 Gy per fraction for 3-4 fractions, aiming to enhance tumor control and stimulate potential immune responses.

A total of 106 patients will be enrolled and randomized 1:1 into the SFRT and CRT arms (53 patients per arm). The primary endpoint is the ORR of the target lesion at 3, 6, 9, and 12 months post-radiotherapy, assessed using RECIST 1.1 and Choi criteria. Secondary endpoints include the 1-year LC of the target lesion, progression-free survival (PFS), safety (per CTCAE v5.0).

Eligibility criteria include patients aged 18-70 years, ECOG performance status ≤2, and an expected survival of ≥3 months, excluding those with secondary primary tumors or severe organ dysfunction. Comprehensive baseline assessments (imaging, pathology, and laboratory tests) are conducted before treatment. Toxicity is monitored weekly during treatment, with ≥grade 3 toxicities prompting treatment suspension. Efficacy evaluations are performed at 3, 6, 9, and 12 months post-radiotherapy, with follow-up scheduled every 3 months in the first year, every 6 months in the second year, and annually thereafter. Statistical analysis is based on a one-sided α=0.05 and β=0.8, anticipating an ORR of 40% for SFRT compared to 15% for CRT.

Through its multicenter design and rigorous evaluation, this study aims to validate whether SFRT can improve ORR in STS, providing scientific evidence to optimize radiotherapy strategies, enhance patient prognosis, and improve QoL. Additionally, it seeks to offer insights into the treatment of other radioresistant tumors.

Вмешательства

• Лучевая терапия Spatially Fractionated Radiotherapy
  SFRT builds on CRT, administered at 3.0 Gy per fraction for 15-20 fractions, with the addition of weekly high-dose vertices of 8-15 Gy per fraction for 3-4 fractions. It employs Intensity-Modulated Radiation Therapy (IMRT), Intensity-Modulated Proton Therapy (IMPT), or Volumetric Modulated Arc Therapy (VMAT) to create a grid-like pattern of alternating high- and low-dose regions. Target volume delineation includes the gross tumor volume (GTV), clinical target volume (CTV, expanded 0.5-1.0 cm fro
• Лучевая терапия Conventional Radiotherapy
  CRT is delivered at 3.0 Gy per fraction for a total of 15-20 fractions, utilizing Intensity-Modulated Radiation Therapy (IMRT) or Intensity-Modulated Proton Therapy (IMPT) techniques, ensuring a target volume dose coverage of at least 90%. Target volume delineation includes the gross tumor volume (GTV), clinical target volume (CTV, expanded 0.5-1.0 cm from GTV), and planning target volume (PTV, expanded 1.0 cm from CTV). Prior to each treatment session, cone-beam CT (CBCT) or kilovoltage cone-be

Первичные конечные точки

• Objective Response Rate (ORR) [Срок оценки: 3、6、9、12months]

Вторичные конечные точки (3)

• Safety Assessment [Срок оценки: 1 year]
• Local Control Rate（LC) [Срок оценки: 1year]
• Progression-Free Survival （PFS) [Срок оценки: 1 year]

Критерии участия

Критерии включения

• 1\. Age 18-70 years, irrespective of gender. 2. Pathologically or clinically confirmed diagnosis of soft tissue sarcoma. 3. Minimum tumor diameter ≥5 cm. 4. Receiving systemic treatment as per multidisciplinary team (MDT) recommendations.

5\. Measurable lesion (per RECIST 1.1/Choi criteria: longest diameter >1.5 cm, or >1 cm with two measurable perpendicular diameters).

6\. ECOG performance status ≤2. 7. Expected survival ≥3 months. 8. Normal liver, kidney, lung, and cardiac function, with tolerance for treatment.

9\. Patients of childbearing potential agree to use reliable contraception during treatment and for one year thereafter.

10\. Voluntary provision of signed informed consent.

Критерии исключения

• (1) Patients with a second primary malignancy. (2) Diagnosis of aggressive fibromatosis or rhabdomyosarcoma. (3) Prior radiotherapy to the target lesion. (4) Tumor unsuitable for radiotherapy. (5) Severe liver, kidney, lung, or cardiac dysfunction, precluding tolerance to systemic therapy or radiotherapy.

(6) Other severe medical conditions that may impact the study (e.g., uncontrolled diabetes, gastric ulcers, or other serious cardiopulmonary diseases).

(7) Severe or uncontrolled infections, or active autoimmune diseases. (8) Clinically evident central nervous system dysfunction. (9) Pregnant or lactating women, or women of childbearing potential not using contraception.

(10) Other conditions deemed unsuitable for participation by the investigator.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Китай · 1 центр

• Shandong Cancer Hospital and Institute — Цзинань

Публикации

• Xu P, Wang S, Zhou J, Yuan K, Wang X, Li L, Lang J, Lu S. Spatially fractionated radiotherapy (Lattice SFRT) in the palliative treatment of locally advanced bulky unresectable head and neck cancer. Clin Transl Radiat Oncol. 2024 Jul 30;48:100830. doi: 10.1016/j.ctro.2024.100830. eCollection 2024 Sep. PMID 39219705
• Moghaddasi L, Reid P, Bezak E, Marcu LG. Radiobiological and Treatment-Related Aspects of Spatially Fractionated Radiotherapy. Int J Mol Sci. 2022 Mar 20;23(6):3366. doi: 10.3390/ijms23063366. PMID 35328787
• Billena C, Khan AJ. A Current Review of Spatial Fractionation: Back to the Future? Int J Radiat Oncol Biol Phys. 2019 May 1;104(1):177-187. doi: 10.1016/j.ijrobp.2019.01.073. Epub 2019 Jan 23. PMID 30684666
• Yang JC, Chang AE, Baker AR, Sindelar WF, Danforth DN, Topalian SL, DeLaney T, Glatstein E, Steinberg SM, Merino MJ, Rosenberg SA. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998 Jan;16(1):197-203. doi: 10.1200/JCO.1998.16.1.197. PMID 9440743
• Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020 Jan;70(1):7-30. doi: 10.3322/caac.21590. Epub 2020 Jan 8. PMID 31912902
• Yan W, Khan MK, Wu X, Simone CB 2nd, Fan J, Gressen E, Zhang X, Limoli CL, Bahig H, Tubin S, Mourad WF. Spatially fractionated radiation therapy: History, present and the future. Clin Transl Radiat Oncol. 2019 Oct 22;20:30-38. doi: 10.1016/j.ctro.2019.10.004. eCollection 2020 Jan. No abstract available. PMID 31768424
• Owen D, Harmsen WS, Ahmed SK, Petersen IA, Haddock MG, Ma DJ, Pulsipher S, Corbin KS, Lester SC, Park SS, Deufel CL, Kavanaugh JA, Grams MP. Highs and Lows of Spatially Fractionated Radiation Therapy: Dosimetry and Clinical Outcomes. Pract Radiat Oncol. 2025 Jul-Aug;15(4):e388-e395. doi: 10.1016/j.prro.2024.12.002. Epub 2024 Dec 24. PMID 39725127
• Grams MP, Deufel CL, Kavanaugh JA, Corbin KS, Ahmed SK, Haddock MG, Lester SC, Ma DJ, Petersen IA, Finley RR, Lang KG, Spreiter SS, Park SS, Owen D. Clinical aspects of spatially fractionated radiation therapy treatments. Phys Med. 2023 Jul;111:102616. doi: 10.1016/j.ejmp.2023.102616. Epub 2023 Jun 11. PMID 37311338

Идентификаторы

NCT: NCT06980259 · SDZLEC2025-075-02

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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