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NCT00643617

CyberKnife Radiosurgery For Low & Intermediate Risk Prostate Cancer: Emulating HDR Brachytherapy Dosimetry

Completed NA Results posted Last updated 9 May 2023
What this trial tests

NA trial testing CyberKnife Stereotactic Radiosurgery - Low Risk in Prostate Cancer in 307 participants. Completed in 7 April 2022.

Timeline
22 October 2007
Primary endpoint
7 April 2022
7 April 2022

Quick facts

Lead sponsorAccuray Incorporated
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationna
Designsingle group
Maskingnone
Primary purposetreatment
Enrollment307
Start date22 October 2007
Primary completion7 April 2022
Estimated completion7 April 2022
Sites18 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

Accuray Incorporated — full company profile →

Who can join

18 and older, male only, with Prostate Cancer or Prostatic Cancer. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Risk for Gastrointestinal (GI) and Genitourinary (GU) Toxicity Primary · Primary Safety Endpoint was measured at 5 years. Sites and patients had the option of continuing follow-up through 10 years.

To estimate the rates of acute and late Grade 3-5 gastrointestinal and genitourinary toxicities (adverse events \[AE\]) observed in both low-risk and intermediate-risk cohorts during the 5 years following CyberKnife (CK) treatment for prostate cancer. Kaplan Meier estimates for 5-yr and 10-yr are reported. Adverse events occurring within 3 months of treatment were categorized as acute toxicities, and those developing after 3 months were considered late toxicities. The rates were determined using the first Grade 3 or higher adverse event per patient, reported as possibly, probably, or definit

Probability of experiencing Acute GI Grade 3+ event(s)
GroupValue95% CI
Low Risk0
Intermediate Risk0
Probability of experiencing Acute GU Grade 3+ event(s)
GroupValue95% CI
Low Risk1.8
Intermediate Risk0.7
Probability of experiencing Late GI Grade 3+ events 5 years post treatment
GroupValue95% CI
Low Risk0
Intermediate Risk0
Probability of experiencing Late GU Grade 3+ events 5 years post treatment
GroupValue95% CI
Low Risk1.0
Intermediate Risk3.7
Probability of experiencing Late GI Grade 3+ event(s) at 10 years post CK treatment
GroupValue95% CI
Low Risk0
Intermediate Risk0
Probability of experiencing Late GU Grade 3+ event(s) at 10 years post CK treatment
GroupValue95% CI
Low Risk1.0
Intermediate Risk3.7
Biochemical Disease-Free Survival (bDFS) Primary · Primary Efficacy Endpoint was measured at 5 years. Sites and patients had the option of continuing follow-up through 10 years.

To determine the rate of biochemical Disease-Free Survival (bDFS), using the Phoenix definition, following CyberKnife treatment. Kaplan Meier survival curves for bDFS were created and the 5-yr and 10-yr percentages are reported. The Phoenix definition uses a Prostate Specific Antigen (PSA) value exceeding the patients lowest PSA value (nadir) + 2 ng/mL as an indicator of disease recurrence. The percentage of patients who did not have such a PSA rise or receive any interventional therapy to treat prostate cancer are reported below.

Probability of remaining disease-free at 5 years post-CyberKnife treatment
GroupValue95% CI
Low Risk100
Intermediate Risk89.1
Probability of remaining disease-free at 10 years post-CyberKnife treatment
GroupValue95% CI
Low Risk100
Intermediate Risk80
Disease Control and Survival Outcomes Secondary · Secondary outcomes were measured at 5 years. Sites and patients had the option of continuing follow-up through 10 years.

To determine the rates of local failure, distant failure, disease-free survival, disease-specific survival, and overall survival following CyberKnife treatment in prostate cancer patients.

Probability of remaining free from Local Failure at 5 years post-CyberKnife treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk100
CyberKnife Stereotactic Radiosurgery - Intermediate Risk98.3
Probability of remaining free from Local Failure at 10 years post-CyberKnife treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk100
CyberKnife Stereotactic Radiosurgery - Intermediate Risk98.3
Probability of remaining free from Distant Failure at 5 years post-CyberKnife treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk100
CyberKnife Stereotactic Radiosurgery - Intermediate Risk95
Probability of remaining free from Distant Failure at 10 years post-CyberKnife treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk100
CyberKnife Stereotactic Radiosurgery - Intermediate Risk95
Probability of remaining free from disease at 5 years post-CyberKnife treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk100
CyberKnife Stereotactic Radiosurgery - Intermediate Risk89.1
Probability of remaining free from disease at 10 years post-CyberKnife treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk100
CyberKnife Stereotactic Radiosurgery - Intermediate Risk80
Probability of surviving prostate cancer at 5 years post-CyberKnife treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk100
CyberKnife Stereotactic Radiosurgery - Intermediate Risk100
Probability of surviving prostate cancer at 10 years post-CyberKnife treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk100
CyberKnife Stereotactic Radiosurgery - Intermediate Risk100
Quality of Life Assessments: American Urological Association (AUA) Symptom Index (SI) Secondary · AUA questionnaire was completed at Baseline, CK Treatment, and post treatment at: 1 week, 1 month, 3 months, 6 months, and then biannually up to 5 years. Sites and patients had the option of continuing follow-up through 10 years.

AUA-SI is a 7-item self-report measure used to assess urinary urgency, frequency, and voiding symptoms with scores ranging from 0 (no symptom) to 5 (symptom occurs almost always) Total score: 0-7 mild symptoms; 8-19 moderate symptoms; 20-35 severe symptoms

Baseline
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk7.05± 6.32
CyberKnife Stereotactic Radiosurgery - Intermediate Risk7.12± 5.79
Last Day of Treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk9.49± 7.53
CyberKnife Stereotactic Radiosurgery - Intermediate Risk8.64± 7.14
1 Week Post Treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk13.57± 9.17
CyberKnife Stereotactic Radiosurgery - Intermediate Risk14.14± 8.85
1 Month Post Treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk11.00± 7.3
CyberKnife Stereotactic Radiosurgery - Intermediate Risk10.74± 6.91
3 Months Post Treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk7.09± 5.55
CyberKnife Stereotactic Radiosurgery - Intermediate Risk7.26± 5.88
6 Months Post Treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk7.78± 7.1
CyberKnife Stereotactic Radiosurgery - Intermediate Risk8.09± 6.51
12 Months Post Treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk8.39± 6.69
CyberKnife Stereotactic Radiosurgery - Intermediate Risk10.05± 7.23
18 Months Post Treatment
GroupValue95% CI
CyberKnife Stereotactic Radiosurgery - Low Risk8.39± 6.9
CyberKnife Stereotactic Radiosurgery - Intermediate Risk10.24± 8.22
Quality of Life Assessments: Expanded Prostate Cancer Index Composite (EPIC) -26 Urinary Incontinence Secondary · Secondary outcomes were measured at 5 years. Sites and patients had the option of continuing follow-up through 10 years.

EPIC-26 is a short form version of the Expanded Prostate Cancer Index Composite, and is a validated comprehensive instrument developed to measure the health-related quality of life among men with prostate cancer. EPIC-26 consists of 26 items under 5 domains of urinary incontinence, urinary irritative/obstructive, bowel, sexual, and hormonal. Answers qualitatively measure patient's bother for each symptom and are then normalized on a scale of 0 (worst) to 100 (best) to calculate domain scores if sufficient input is provided.

Baseline
GroupValue95% CI
Low Risk95.77± 10.42
Intermediate Risk91.59± 14.39
1 Month Post Treatment
GroupValue95% CI
Low Risk90.33± 14.56
Intermediate Risk88.83± 16.85
6 Months Post Treatment
GroupValue95% CI
Low Risk92.81± 14.08
Intermediate Risk88.48± 16.51
12 Months Post Treatment
GroupValue95% CI
Low Risk90.64± 17.39
Intermediate Risk85.37± 19.23
24 Months Post Treatment
GroupValue95% CI
Low Risk87.66± 17.32
Intermediate Risk78.44± 25.72
36 Months Post Treatment
GroupValue95% CI
Low Risk90.2± 19.38
Intermediate Risk81.08± 22.8
48 Months Post Treatment
GroupValue95% CI
Low Risk88.74± 20.88
Intermediate Risk80.62± 22.11
60 Months Post Treatment
GroupValue95% CI
Low Risk89.5± 18.31
Intermediate Risk80.04± 20.8
Quality of Life Assessments: EPIC-26 Urinary Irritative Obstructive Secondary · Secondary outcomes were measured at 5 years. Sites and patients had the option of continuing follow-up through 10 years.

EPIC-26 is a short form version of the Expanded Prostate Cancer Index Composite, and is a validated comprehensive instrument developed to measure the health-related quality of life among men with prostate cancer. EPIC-26 consists of 26 items under 5 domains of urinary incontinence, urinary irritative/obstructive, bowel, sexual, and hormonal. Answers qualitatively measure patient's bother for each symptom and are then normalized on a scale of 0 (worst) to 100 (best) to calculate domain scores if sufficient input is provided.

Baseline
GroupValue95% CI
Low Risk87.67± 13.96
Intermediate Risk87.59± 12.32
1 Month Post Treatment
GroupValue95% CI
Low Risk74.11± 17.49
Intermediate Risk74.03± 17.82
6 Months Post Treatment
GroupValue95% CI
Low Risk86.75± 14.69
Intermediate Risk82.91± 17.4
12 Months Post Treatment
GroupValue95% CI
Low Risk83.29± 15.45
Intermediate Risk80.1± 18.79
24 Months Post Treatment
GroupValue95% CI
Low Risk86.56± 15.09
Intermediate Risk81.05± 18.71
36 Months Post Treatment
GroupValue95% CI
Low Risk86.99± 15.09
Intermediate Risk85.77± 16.77
48 Months Post Treatment
GroupValue95% CI
Low Risk87.81± 13.03
Intermediate Risk84.03± 16.36
60 Months Post Treatment
GroupValue95% CI
Low Risk87.72± 14.9
Intermediate Risk84.15± 14.32
Quality of Life Assessments: EPIC-26 Bowel Secondary · Secondary outcomes were measured at 5 years. Sites and patients had the option of continuing follow-up through 10 years.

EPIC-26 is a short form version of the Expanded Prostate Cancer Index Composite, and is a validated comprehensive instrument developed to measure the health-related quality of life among men with prostate cancer. EPIC-26 consists of 26 items under 5 domains of urinary incontinence, urinary irritative/obstructive, bowel, sexual, and hormonal. Answers qualitatively measure patient's bother for each symptom and are then normalized on a scale of 0 (worst) to 100 (best) to calculate domain scores if sufficient input is provided.

Baseline
GroupValue95% CI
Low Risk96.25± 8.14
Intermediate Risk94.84± 9.96
1 Month Post Treatment
GroupValue95% CI
Low Risk89.32± 14.63
Intermediate Risk86.05± 16.66
6 Months Post Treatment
GroupValue95% CI
Low Risk93.45± 12.06
Intermediate Risk89.92± 15.91
12 Months Post Treatment
GroupValue95% CI
Low Risk93.51± 11.41
Intermediate Risk87.97± 17.42
24 Months Post Treatment
GroupValue95% CI
Low Risk93.68± 11.16
Intermediate Risk89.28± 17.26
36 Months Post Treatment
GroupValue95% CI
Low Risk94.82± 9.27
Intermediate Risk93.29± 12.48
48 Months Post Treatment
GroupValue95% CI
Low Risk94.65± 9.77
Intermediate Risk92.04± 12.28
60 Months Post Treatment
GroupValue95% CI
Low Risk94.49± 11.67
Intermediate Risk91.03± 15.38
Quality of Life Assessments: EPIC-26 Sexual Secondary · Secondary outcomes were measured at 5 years. Sites and patients had the option of continuing follow-up through 10 years.

EPIC-26 is a short form version of the Expanded Prostate Cancer Index Composite, and is a validated comprehensive instrument developed to measure the health-related quality of life among men with prostate cancer. EPIC-26 consists of 26 items under 5 domains of urinary incontinence, urinary irritative/obstructive, bowel, sexual, and hormonal. Answers qualitatively measure patient's bother for each symptom and are then normalized on a scale of 0 (worst) to 100 (best) to calculate domain scores if sufficient input is provided.

Baseline
GroupValue95% CI
Low Risk55.27± 33.41
Intermediate Risk56.32± 32.6
1 Month Post Treatment
GroupValue95% CI
Low Risk47.46± 33.58
Intermediate Risk50.58± 31.82
6 Months Post Treatment
GroupValue95% CI
Low Risk50.06± 31.91
Intermediate Risk51.23± 33.47
12 Months Post Treatment
GroupValue95% CI
Low Risk44.86± 34.82
Intermediate Risk45.2± 32.46
24 Months Post Treatment
GroupValue95% CI
Low Risk40.77± 32.15
Intermediate Risk39.73± 30.39
36 Months Post Treatment
GroupValue95% CI
Low Risk42.5± 33.57
Intermediate Risk40.99± 31.59
48 Months Post Treatment
GroupValue95% CI
Low Risk38.3± 31.56
Intermediate Risk38.95± 31.8
60 Months Post Treatment
GroupValue95% CI
Low Risk32.22± 31.16
Intermediate Risk36.89± 32.44

Adverse events — posted to ClinicalTrials.gov

Time frame: Adverse event data collected from study enrollment through end of protocol follow-up, including fiducial placement, CyberKnife radiosurgery treatment, and scheduled follow-up visits up to 10 years post-CK treatment.. Reporting threshold: 5%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Low Risk
Serious: 17/112 (15%)
Deaths: 9/112
Intermediate Risk
Serious: 25/147 (17%)
Deaths: 14/147

Serious adverse events (26 terms)

ReactionSystemLow RiskIntermediate Risk
Other MalignancyNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Death NOSGeneral disorders
InfectionInfections and infestations
CNS IschemiaNervous system disorders
Cardiac Ischemia/InfarctionCardiac disorders
Hemorrhage/BleedingGastrointestinal disorders
Syncope (fainting)Nervous system disorders
Cardiac arrhythmiaCardiac disorders
Cardiopulmonary ArrestCardiac disorders
Coronary Artery DiseaseCardiac disorders
Valvular Heart DiseaseCardiac disorders
Ischemic ColitisGastrointestinal disorders
Obstruction (Small Bowel)Gastrointestinal disorders
Hemorrhage/BleedingRenal and urinary disorders
HyponatremiaMetabolism and nutrition disorders
Cervical Spine StenosisMusculoskeletal and connective tissue disorders
Mood AlterationNervous system disorders
Transverse MyelitisNervous system disorders
PainMusculoskeletal and connective tissue disorders
HeadacheNervous system disorders
Plane crashGeneral disorders
Respiratory FailureRespiratory, thoracic and mediastinal disorders
PneumonitisRespiratory, thoracic and mediastinal disorders
Urinary RetentionRenal and urinary disorders
Aortic AtheromaVascular disorders
Other adverse events (19 terms — click to expand)

ReactionSystemLow RiskIntermediate Risk
Urinary Frequency/UrgencyRenal and urinary disorders
Pain - GURenal and urinary disorders
Urinary RetentionRenal and urinary disorders
DiarrheaGastrointestinal disorders
FatigueGeneral disorders
Hemorrhage/Bleeding - GURenal and urinary disorders
Erectile DysfunctionReproductive system and breast disorders
Urinary IncontinenceRenal and urinary disorders
GI PainGastrointestinal disorders
ConstipationGastrointestinal disorders
Hemorrhage/Bleeding - GIGastrointestinal disorders
ProctitisGastrointestinal disorders
CystitisRenal and urinary disorders
Pain - MusculoskeletalMusculoskeletal and connective tissue disorders
UrgencyGastrointestinal disorders
Urinary Tract InfectionRenal and urinary disorders
HematospermiaReproductive system and breast disorders
Pain - Reproductive/SexualReproductive system and breast disorders
Ejaculatory DysfunctionReproductive system and breast disorders

Most-reported serious reactions: Other Malignancy, Death NOS, Infection, CNS Ischemia, Cardiac Ischemia/Infarction, Hemorrhage/Bleeding, Syncope (fainting), Cardiac arrhythmia.

Data from ClinicalTrials.gov NCT00643617 adverse events section.

Sponsor's own description

The purpose of this study is to investigate the effects of CyberKnife radiosurgery in patients with early stage organ-confined prostate cancer and to evaluate the effects of this treatment on the quality of life over time.

Publications & conference data

3 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer.
    Kishan AU, Dang A, Katz AJ, Mantz CA, et al · · 2019 · cited 253× · PMID 30735235 · DOI 10.1001/jamanetworkopen.2018.8006
  2. Hypofractionation for prostate cancer.
    Ritter M, Forman J, Kupelian P, Lawton C, et al · · 2009 · cited 55× · PMID 19197165 · DOI 10.1097/ppo.0b013e3181976614
  3. High Dose "HDR-Like" Prostate SBRT: PSA 10-Year Results From a Mature, Multi-Institutional Clinical Trial.
    Fuller DB, Crabtree T, Kane BL, Medbery CA, et al · · 2022 · cited 9× · PMID 35965547 · DOI 10.3389/fonc.2022.935310

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