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NCT Number: NCT06142760

MR-guidance in Chemoradiotherapy for Cervical Cancer

Concurrent chemoradiotherapy (CCRT), consisting of external beam radiotherapy (EBRT) and chemotherapy, followed by brachytherapy (BT) is the standard of care for patients with locally advanced cervical carcinoma. In current clinical practice, conventionally, one radiotherapy plan based on the initial planning computed tomography (CT) and magnetic resonance imaging (MRI) scan of the pelvis is applied for the complete 5-6 weeks of EBRT. However, there is a high degree of cervix and uterus motion in the pelvis due to different fillings of the bladder and the bowel. Consequently, large safety margins are required to compensate for organ movement, potentially leading to higher toxicity. Lately, daily high-quality cone-beam CT (CBCT) guided adaptive radiotherapy, aided by artificial intelligence (AI), became clinically available. Due to the improved soft-tissue contrast, the treatment plan can now be online adapted to the current position of the tumor and the adjacent organs-at-risk (OAR), while the patient is lying on the treatment couch. Moreover, the German Research Cancer Center offers the unique possibility of additional weekly magnetic resonance imaging (MRI) in treatment position using a shuttle system. Daily CBCT-adapted EBRT in combination with weekly MRI in treatment position might therefore offer superior sparing of surrounding OAR and consequently reduction of treatment-associated side-effects.

However, to the investigators knowledge, no toxicity data for daily CBCT/AI adaptive EBRT of locally advanced cervical cancer with additional MR-guidance exists. The AIM-C1 trial therefore aims to assess the potential of daily CBCT adaptive and AI aided EBRT combined with additional weekly offline MR-guidance in treatment position using a shuttle system.

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Key information

Conditions

Cervical Cancer Female Urogenital Diseases Female Urogenital Diseases and Pregnancy Complications Genital Diseases Genital Diseases, Female Genital Neoplasms, Female Neoplasms Neoplasms by Site Urogenital Diseases Urogenital Neoplasms Uterine Cervical Diseases Uterine Cervical Neoplasms Uterine Diseases Uterine Neoplasms

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

University Hospital of Heidelberg, Radiation Oncology

Heidelberg, 69120, Germany

Location status: Recruiting

Location contact

Juliane Hörner-Rieber, MD

PRINCIPAL_INVESTIGATOR

About this study

This trial will be conducted as a prospective, one-armed phase II study in 40 patients with cervical carcinoma (FIGO stage IB, IIA, IIB, IIIA, IIIB, IIIC1), age ≥ 18 years, Karnofsky Performance Score ≥ 70%. CCRT will consist of 50.4Gy external beam radiotherapy (EBRT) with concurrent cisplatin 40mg/m² as standard of care in Germany, followed by 27Gy of BT in 4 fractions of 7Gy.

The primary endpoint of the trial will be the occurrence of overall early bowel and bladder toxicity CTCAE grade 2 or higher assessed within the first 3 months with NCI CTCAE Version 5.0.

Secondary outcomes to be investigated are clinical feasibility of daily CBCT-guided and weekly MR-guided plan adaptation, local tumor control, distant tumor control, progression-free survival, overall survival, quality of life, acquisition and comparison of different MRI sequences, technical analyses of treatment, adaptation frequency and morphological as well as functional tumor characteristics of the MRI.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • biopsy-proven cervical cancer including squamous-cell carcinoma, adenocarcinoma or adeno-squamous cell carcinoma
  • FIGO stage IB, IIA, IIB, IIIA, IIIB, IIIC1
  • indication and eligibility for definitive chemoradiotherapy including brachytherapy discussed in an interdisciplinary tumor board
  • Karnofsky performance score ≥ 70%
  • 18-80 years of age
  • Capacity of the patient to consent to participation in the study

Exclusion criteria

  • FIGO stage IIIC2 and IV
  • Paraaortic lymphatic node metastases
  • small cell neuroendocrine cancer, melanoma and other rare cancers of the cervix
  • previous radiotherapy of the pelvic region
  • previous total or partial hysterectomy
  • neoadjuvant chemotherapy
  • contraindications against performing contrast-enhanced MRI scans (pacemakers, other implants making MRI impossible, allergy to gadolinium (GD)-based contrast agent)
  • claustrophobia
  • pregnant or lactating women
  • other primary malignancies within 5 years before except carcinoma in situ of the cervix and basal cell carcinoma of the skin
  • patient is enrolled in another study, that could influence the outcome of the presented study

Treatment and study plan

MR-guided radiation

Radiation

Dayly artifical intelligence-based treatment adaptation under weekly offline MR-guidance

Primary outcomes

  1. Treatment-related bladder toxicity

    Time frame: within 3 month after completion of radiation treatment

    Occurrence of bladder toxicity grade 2 or higher according to CTCAE V5.0

  2. Treatment-related bowl toxicity

    Time frame: within 3 month after completion of radiation treatment

    Occurrence of bowl toxicity grade 2 or higher according to CTCAE V5.0

Study contacts

Contact information is provided by the study sponsor or research team.

Juliane Hörner-Rieber, MD

CONTACT

[email protected]

+496221 56 ext. 8201

Sponsors and collaborators

Lead sponsor

Juergen Debus

Other

Registry information

Official study title

Daily AI-based Treatment Adaptation Under Weekly Offline MR-guidance in Chemoradiotherapy for Cervical Cancer 1 AIM-C1

Acronym: AIM-C1

Important dates

Study start
2023
Primary completion
2026
Study completion
2027
First posted
Nov 21, 2023
Registry last updated
Mar 9, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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