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| ID | Type | Description | Link |
|---|---|---|---|
| S-20250058 | Other Identifier | Ethics committee |
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| Name | Class |
|---|---|
| Danish Cancer Society | OTHER |
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This single-arm phase 2 trial investigates whether a single high-dose radiotherapy treatment can safely treat men whose prostate cancer has come back in a small number of lymph nodes in the pelvis or abdomen after curative treatment. Participants receive one fraction of 24 Gy delivered with MR-guided stereotactic body radiotherapy (SBRT), which uses MRI to visualise the tumour and surrounding organs during treatment. The main goal is to assess safety (severe side effects). The trial also evaluates local tumour control, longer-term side effects, time until hormone (androgen deprivation) therapy is needed, survival, and quality of life. The trial aims to enrol 48 patients.
PINPOINT is a prospective, investigator-initiated, single-centre, single-arm phase 2 trial of single-fraction MR-guided SBRT in patients with nodal oligorecurrent prostate cancer. Eligible men have PSMA-PET/CT-verified nodal relapse in the pelvis or abdomen following curatively intended local treatment.
All patients are simulated with MRI in treatment position and treated with 24 Gy in 1 fraction to the gross tumour volume (GTV) using inverse-planned step-and-shoot IMRT on an MR-linac. No CTV margin is added (CTV = GTV); PTV margins account for motion and set-up uncertainty. Normal-tissue constraints are prioritised over target coverage.
The primary endpoint is cumulative CTCAE v5 grade ≥4 treatment-related toxicity within 6 months. Sample size follows a Simon two-stage design (H0: grade 4-5 TRAE rate 15%; H1: 4%; one-sided α = 5%, power 80%), with an interim analysis after 6-month follow-up of the first 16 patients and a total of 48 patients. Follow-up continues for 5 years. Toxicity (CTCAE v5), quality of life (EQ-5D-5L, EORTC QLQ-C30) and patient-reported outcomes (PRO-CTCAE) are collected at baseline and through follow-up; PSA and PSMA-PET/CT (on rising PSA) follow standard of care.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Single-fraction MR-guided SBRT | Experimental | All participants receive 24 Gy in a single fraction to the GTV, delivered with MR-guided SBRT. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Single-fraction SBRT | Radiation | Participants will receive 24 Gy in 1 fraction to a lymph node. |
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| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants with cumulative CTCAE v5.0 grade ≥4 treatment-related adverse events | The NCI Common Terminology Criteria for Adverse Events (CTCAE) v5.0 measures side-effects. Possible scores range from 0-5, with higher scores indicating a worse outcome. | Within 6 months after completion of radiotherapy |
| Measure | Description | Time Frame |
|---|---|---|
| Number of participants with late adverse events (CTCAE v5.0) | The NCI Common Terminology Criteria for Adverse Events (CTCAE) v5.0 measures side-effect. Possible scores range from 0-5, with higher scores indicating a worse outcome. | 1, 1,5, 2, 3 and 5 years |
| Percentage of participants free from local progression (PSMA-PET/CT-verified), estimated by time-to-event analysis |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Kristine S Nielsen, MD | Contact | +45 31269894 | kristine.skovly.nielsen@rsyd.dk | |
| Tine Schytte, Professor | Contact | +45 21421114 | tine-schytte@rsyd.dk |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Oncology, Odense University Hospital | Odense | Denmark |
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| ID | Term |
|---|---|
| D011471 | Prostatic Neoplasms |
| D008207 | Lymphatic Metastasis |
| ID | Term |
|---|---|
| D005834 | Genital Neoplasms, Male |
| D014565 | Urogenital Neoplasms |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
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Defined as freedom from PSMA-verified relapse within the treated area. In the case of significant increase in PSA, a PSMA will be performed as to local guidelines. Local control will be evaluated at a lesion level, lesion by lesion. Within the treated area is defined as within or adjacent to the planning target volume (PTV). |
| From radiotherapy until local progression or last follow-up, up to 5 years |
| Median clinical progression-free survival | Defined as time from inclusion to any new node or distant metastases recurrence. | From radiotherapy up to 5 years |
| Median time to initiation of palliative ADT (ADT-free survival) | ADT-free survival is defined as the time from trial randomization to start of hormonal treatment | From inclusion up to 5 years |
| Number of participants with acute adverse events (CTCAE v5.0), by maximum grade | The NCI Common Terminology Criteria for Adverse Events (CTCAE) v5.0 measures side-effects. Possible scores range from 0-5, with higher scores indicating a worse outcome. | Within 6 months after radiotherapy |
| Median overall survival | Overall survival is defined as time form inclusion to death from any cause | From inclusion up to 5 years |
| Mean change from baseline in EQ-5D-5L index (utility) score | The EQ-5D-5L is a standardized, validated generic instrument for health-related quality of life. It comprises five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), each with five response levels. Responses are converted to a single summary index (utility) score using a country-specific (Danish) value set, anchored at 1 = full health and 0 = death, with negative values possible for health states considered worse than death; higher scores indicate better health-related quality of life. The outcome is reported as the mean change from baseline in the EQ-5D-5L index score at each assessment time point. | Baseline, 2 weeks, 3,6 and 12 months |
| Mean change from baseline in EORTC QLQ-C30 Global Health Status / QoL scale score | The EORTC QLQ-C30 (version 3.0) is a validated cancer-specific questionnaire for assessing health-related quality of life in clinical trials. It contains 30 items comprising a global health status / quality of life scale, five functional scales (physical, role, emotional, cognitive, and social functioning), three symptom scales (fatigue, nausea/vomiting, and pain), and several single-item symptom and financial-impact measures. Raw scores are linearly transformed to a 0-100 scale according to the EORTC scoring manual; for the global health status / QoL scale a higher score indicates better quality of life. This outcome is reported as the mean change from baseline in the global health status / QoL scale score at each assessment time point. | Baseline, 2 weeks, 3, 6 and 12 months |
| Number of participants reporting symptomatic adverse events as assessed by PRO-CTCAE | PRO-CTCAE (Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) is a validated patient-reported measurement system developed by the NCI to capture symptomatic toxicity in cancer clinical trials. A predefined subset of PRO-CTCAE items is used in this trial. Each symptom is rated by the patient over the prior 7 days across the applicable attributes - frequency (never to almost constantly), severity (none to very severe), and/or interference with usual or daily activities (not at all to very much) - each on a 5-point ordinal scale (scored 0-4). The outcome is reported as the number of participants in each response category per item and attribute at each assessment time point. | Baseline, 2 weeks, 3,6 and 12 months |
| D005832 |
| Genital Diseases, Male |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D011469 | Prostatic Diseases |
| D052801 | Male Urogenital Diseases |
| D009362 | Neoplasm Metastasis |
| D009385 | Neoplastic Processes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |