ClinicalTrials.gg
CompletedNCT03307538STRONGUpdated Jan 26, 2021

Stereotactic Body Radiation Therapy for Unresectable Perihilar Cholangiocarcinoma

An interventional study of Stereotactic body radiation therapy in Klatskin Tumor, sponsored by Erasmus Medical Center. Completed at 1 site in Netherlands. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-01-26.

Sponsored by Erasmus Medical Center · Not applicable, Interventional, and Treatment

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Phase
Not applicable
Study type
Interventional
Enrollment
6
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Study summary

Rationale:

For patients with perihilar cholangiocarcinoma, surgery is the only treatment modality that can result in cure. Unfortunately, in the majority of these patients the tumors are found to be unresectable at presentation due to local invasive tumor growth or the presence of distal metastases. For patients with unresectable cholangiocarcinoma palliative chemotherapy is the standard treatment yielding an estimated median overall survival of 12-15.2 months. There is no evidence from randomized trials that support the routine use of stereotactic body radiation therapy (SBRT) for cholangiocarcinoma. However, small and most often retrospective studies combining chemotherapy with SBRT showed promising results with overall survival reaching up to 33-35 months.

Based upon these observations, the investigators designed a local feasibility trial with SBRT after chemotherapy in patients with unresectable perihilar cholangiocarcinoma in order to try to confirm the observed tolerability of adding SBRT to standard chemotherapy. The expected time to include the required patients for this pilot study will be one year.

Objective:

To assess feasibility of SBRT as add on treatment after standard chemotherapy.

Study design:

Local feasibility trial.

Study population:

Patients diagnosed with perihilar cholangiocarcinoma, 18 years of age or older, T1-4 N0-1 M0 (AJCC 7th Edition), after completion of standard chemotherapy. Exclusion criteria are local tumor growth into either stomach, colon, duodenum, pancreas or abdominal wall. Sample size will be 6 patients.

Intervention:

SBRT will be delivered in 15 fractions of 3 to 4.5Gy after 8 cycles of chemotherapy. In case of toxicity causing premature termination of systemic treatment, the patient can still proceed to SBRT.

Main study parameters/endpoints:

The primary endpoint of this study is feasibility measured by radiotherapy induced toxicity according to CTC v4.0.3.

Secondary endpoints will be:

  • Quality of life
  • Local progression
  • Progression free survival
  • Overall survival
  • Cellular radiosensitivity.
Read the detailed description

For patients with perihilar cholangiocarcinoma, surgery is the only treatment modality that can result in cure. Unfortunately, in the majority of these patients the tumors are found to be unresectable at presentation due to local invasive tumor growth or the presence of distant metastases. For these patients palliative chemotherapy is the standard treatment yielding an estimated median overall survival of 12-15.2 months. There is no evidence from randomized trials that supports the routine use of stereotactic body radiation therapy (SBRT) for unresectable cholangiocarcinoma. However, small and most often retrospective studies combining chemotherapy with SBRT showed promising results with overall survival reaching up to 33-35 months.

This pilot study is designed as a first step to confirm and extend these findings. Up to six patients diagnosed with unresectable perihilar cholangiocarcinoma will be treated with standard chemotherapy followed by SBRT in order to assess possible severe side effects of the treatment. As part of this research, patients will be followed with CT- or MRI-scan and blood tests exams until progression. In addition to this clinical evaluation, the investigators will also work towards developing a predictive assay for radiotherapy response of both normal and tumor tissue by establishing normal tissue and tumor organoids and determining several key parameters for their response to ionizing radiation treatment.

02

Conditions studied

  • Klatskin Tumor

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Keywords

  • Perihilar cholangiocarcinoma
  • Klatskin tumor
  • Stereotactic body radiation therapy
03

In context

Klatskin Tumor

82 studies on the registry are indexed under Klatskin Tumor; 27 are open to participants now.

This study's enrollment of 6 is below the median of 55 across 56 interventional studies indexed under Klatskin Tumor.

Browse Klatskin Tumor studies →

Lead sponsor

Erasmus Medical Center is the lead sponsor of 478 studies on the registry; 182 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

In order to be eligible to participate in this study, a subject must be discussed in a multidisciplinary liver tumor board and should meet all of the following criteria:

  • Patients diagnosed with perihilar cholangiocarcinoma according to the criteria of the Mayo Clinic, Rochester:

    • Positive or strongly suspicious intraluminal brush or or,
    • A radiographic malignant appearing stricture plus either:

      • CA 19-9>100 U/ml in the absence of acute bacterial cholangitis, or
      • polysomy on FISH, or
      • a well-defined mass on cross sectional imaging.
  • One tumor mass
  • Unresectable tumor
  • Finished chemotherapy treatment with Gemcitabine and Cisplatin, preferably 8 cycles. If less cycles are given, patients are still eligible for this study.
  • T1-T4 (AJCC staging 7th edition), before chemotherapy
  • N0-N1 (AJCC staging 7th edition), radiologically or pathologically suspect, before chemotherapy
  • to be selected as a target on CT/MRI-scan, according to criteria, after chemotherapy within 6 weeks prior to inclusion
  • Tumor visibility on CT
  • If liver cirrhosis is present, it should be well compensated, with grade A.
  • Age ≥ 18 years
  • performance status 0-1
  • ≤1.5 times normal value, /ALT ≤5 times , within 6 weeks prior to inclusion
  • ≥ 50x10E9/ l, Leukocytes > 1.5x10E9/l, > 6 mmol/l, within 6 weeks prior to inclusion
  • Written , after chemotherapy
  • Willing and able to comply to the follow-up schedule
  • Able to start SBRT within 12 weeks after completion of chemotherapy.

Exclusion criteria

Exclusion criteria:

  • Eligibility for resection
  • Prior surgery or transplantation
  • Multifocal tumor
  • Tumor extension in stomach, colon, duodenum, pancreas or abdominal wall.
  • N2, (AJCC staging 7th edition), radiologically or pathologically suspect, before chemotherapy
  • Distant
  • Progression (local or distant) during or after chemotherapy Ascites
  • Previous radiotherapy to the liver
  • Current pregnancy
Terms in these criteria, in plain language(12)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Biopsy and archival tissue

A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.

Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.

Measurable disease

The amount of disease can be tracked with a defined measurement, so the study can see whether it shrinks or grows. It might be a tumour measured on a scan or, in some blood cancers such as myeloma, a marker measured in blood or urine.

The criteria or the study team say which measurement counts — having no tumour visible on a scan does not by itself rule you out.

RECIST

The standard rules for measuring tumours on CT or MRI scans, to tell whether a cancer is shrinking, stable or growing during treatment.

“Measurable disease per RECIST 1.1” usually means at least one tumour 10 mm or more at its longest on a CT scan, or a lymph node 15 mm or more across its short axis.

Child-Pugh class

A score of how well the liver works in people with liver disease such as cirrhosis: class A is mild, B moderate and C severe.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
6 participants (actual)

Study arms

  • Experimental
    Stereotactic body radiation therapy

    Radiation: Stereotactic body radiation therapy

Interventions

  • RadiationStereotactic body radiation therapy

    15 fractions of 3-4,5 Gy (risk-adapted)

06

What researchers measure

Primary outcomes

  1. Acute toxicity

    Limiting toxicity will be defined as more than one patient with grade 4 hepatobiliary toxicity related to study procedures, or more than one patient with grade 3 gastrointestinal toxicity related to study procedures, occurring in the period up to 3 months after the last SBRT administration.

    Time frame: 3 months

Secondary outcomes

  1. Quality of life

    Assessed by means of the EORTC QLQ-C30 questionnaire

    Time frame: 2 years

  2. Quality of life

    Assessed by means of the EORTC QLQ-BIL21 questionnaire

    Time frame: 2 years

  3. Quality of life

    Assessed by means of the EuroQoL-5D questionnaire

    Time frame: 2 years

  4. Local progression

    Measured on CT

    Time frame: 2 years

  5. Local progression

    Measured on MRI

    Time frame: 2 years

  6. Progression free survival

    Time from treatment to progression measured on CT

    Time frame: 2 years

  7. Overall survival

    Time frame: 2 years

  8. Cellular radiosensitivity

    A predictive assay will be developed for radiotherapy response of both normal and tumor tissue by establishing normal tissue and tumor organoids and determining several key parameters for their response to ionizing radiation treatment.

    Time frame: 2 years

07

Study locations

1 site
  • Erasmus MC
    Rotterdam, Zuid Holland 3015 CE, Netherlands
08

References and documents

Publications

  • Baak R, Willemssen FEJA, van Norden Y, Eskens FALM, Milder MTW, Heijmen BJM, Koerkamp BG, Sprengers D, van Driel LMJW, Klumpen HJ, den Toom W, Koedijk MS, IJzermans JNM, Mendez Romero A. Stereotactic Body Radiation Therapy after Chemotherapy for Unresectable Perihilar Cholangiocarcinoma: The STRONG Trial, a Phase I Safety and Feasibility Study. Cancers (Basel). 2021 Aug 7;13(16):3991. doi: 10.3390/cancers13163991. PubMed 34439146 ↗
  • Koedijk MS, Heijmen BJM, Groot Koerkamp B, Eskens FALM, Sprengers D, Poley JW, van Gent DC, van der Laan LJW, van der Holt B, Willemssen FEJA, Mendez Romero A. Protocol for the STRONG trial: stereotactic body radiation therapy following chemotherapy for unresectable perihilar cholangiocarcinoma, a phase I feasibility study. BMJ Open. 2018 Oct 15;8(10):e020731. doi: 10.1136/bmjopen-2017-020731. PubMed 30327398 ↗

Individual participant data

Plan to share: No

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Ran from Nov 2017 to primary completion in Mar 2020, 28 months.

How these figures are worked out, and which studies are left out of them.

Registered
Sep 26, 2017
First posted
Oct 11, 2017
StartActual
Nov 6, 2017
Primary completionActual
Mar 30, 2020
CompletionActual
Jun 30, 2020
Last update
Jan 26, 2021
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Jan 26, 2021, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT03307538
Responsible party
Alejandra Mendez Romero (A. Méndez Romero MD, PhD, Erasmus Medical Center) — Principal investigator
First posted
Oct 11, 2017
Start date
Nov 6, 2017
Primary completion
Mar 30, 2020
Completion
Jun 30, 2020
Last update
Jan 26, 2021

Study contacts

Alejandra Méndez Romero, MD, PhD
principal investigator · Erasmus Medical Center

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Jan 2021. You cannot join it, but the record below documents what was studied.

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