Feasibility of Semi-Permanent Tattoo for Treatment Alignment in Radiation Therapy
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ClinicalTrials.gov Identifier: NCT05248009 |
Recruitment Status :
Active, not recruiting
First Posted : February 21, 2022
Last Update Posted : June 22, 2023
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Condition or disease | Intervention/treatment | Phase |
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Tattoo; Pigmentation Cancer, Treatment-Related | Device: Semi-Permanent Tattoo Ink | Not Applicable |
Over 3 million patients are treated each year with radiation therapy, with most of these patients receiving permanent tattoos for treatment alignment. The purpose of these tattoos is to ensure accurate initial patient position prior to treatment. In the case where further on-board imaging such as x-ray or cone-beam CT is used, the radiation tattoos help minimize large shifts which increase treatment time and radiation exposure as further imaging may be required. The tattoos are simple and effective, but also permanent. These permanent tattoos serve as a daily reminder of prior radiation therapy in cancer survivors which may have a negative psychological impact on the patients quality of life. Due to this, many patients will seek laser tattoo removal after completing radiation therapy. There have been attempts at non-permanent tattoo options such as henna as well as omitting tattoos altogether using surface imaging. Unfortunately, henna and other temporary tattoos start to fade quickly and do not last the 6-8 weeks required for longer radiation courses. This means that the tattoos must be reapplied over the course of treatment which can introduce inaccuracies as well as prolongs the treatment time.
A novel semi-permanent ink has been developed and recently released which begins to fade after 6 months and disappears after about 1 year. This is the first ink of its kind and is delivered using a needle into the dermis just like a permanent tattoo, however it is able to be resorbed by the body after approximately 1 year. While the original purpose is for cosmetic tattoos it has a possible application in medical tattoos for radiation therapy.
It is the goal of this study to show that the semi-permanent ink is safe, allows for accurate alignment of the patient prior to treatment, lasts long enough for a full treatment course, and fades over time. The goal in subsequent studies is to improve patient quality of life by decreasing the negative psychological impact of having permanent tattoos following radiation therapy.
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 15 participants |
Allocation: | N/A |
Intervention Model: | Single Group Assignment |
Intervention Model Description: | Single Arm Pilot Trial |
Masking: | None (Open Label) |
Primary Purpose: | Supportive Care |
Official Title: | Feasibility of Semi-Permanent Tattoo for Treatment Alignment in Radiation Therapy |
Actual Study Start Date : | June 23, 2022 |
Estimated Primary Completion Date : | April 7, 2024 |
Estimated Study Completion Date : | July 2024 |
Arm | Intervention/treatment |
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Experimental: Semi-Permanent Tattoo Ink
Semi-Permanent Tattoo Ink
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Device: Semi-Permanent Tattoo Ink
Subjects will receive semi-permanent tattoo ink in place of the permanent ink utilized in the standard of care. Subjects will be monitored during their treatment course and for 15 months following treatment completion. |
- Skin Adverse Events - During Treatment [ Time Frame: Subjects will be followed weekly during their treatment course ]Adverse events related to the tattooing process including skin toxicity during the completion of radiation therapy will be assessed using Common Terminology Criteria for Adverse Events (CTCAE v5). The type, incidence, severity, timing, serious, and relatedness of AE and laboratory abnormalities will be reported and tabulated. The CTCAE is assessed according to grades 1-5, where grade 5 constitutes the highest severity and worse outcome.
- Mean 3D Vector Shifts [ Time Frame: Subjects will be followed until completion of their 5-7 week treatment course ]The primary endpoint is the mean 3D vector shifts as determined by couch shifts from initial setup using tattoo to final treatment position which is verified and shifted based on further imaging including x-ray or cone-beam CT scan. Mean and standard deviation of 3D vector shifts will be summarized, and t-test or Mann-Whitney test will be used to compared with historical data.
- Skin Adverse Events - Post Treatment [ Time Frame: Subjects will be followed every 3 months for 15 months after completion of treatment ]Adverse events related to the tattooing process including skin toxicity during the completion of radiation therapy will be assessed using Common Terminology Criteria for Adverse Events (CTCAE v5). The type, incidence, severity, timing, serious, and relatedness of AE and laboratory abnormalities will be reported and tabulated. The CTCAE is assessed according to grades 1-5, where grade 5 constitutes the highest severity and worse outcome.
- Change from Baseline Tattoo Visibility at 15 Months [ Time Frame: Subjects will be followed weekly during their 5-7 week treatment course and every 3 months for 15 months after completion of treatment ]The second primary endpoint will be tattoo visibility which will be scored on a 4-point scale and assessed until end of follow up. The scoring ranges from 0-3, with 0 representing not visible and 3 representing easily visible. This will be assessed weekly during treatment by both the treating physician/research team as well as the patient. Tattoo fading will be compared to baseline which is measured during the first week of radiation therapy to give time to heal after tattoo placement at time of simulation. Tattoo visibility score from baseline for each patient will be summarized by spaghetti plot. Time to complete invisible will be summarized by Kaplan-Meier method.
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patients requiring medical tattoo for treatment alignment.
- Patient being treated with some form of image guidance including kV, MV, or cone-beam CT.
- Age ≥ 18.
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2.
- Patients will engage in the informed consent process and provide study-specific informed consent prior to study entry and must be willing to have photos taken of their tattoos through the treatment and follow-up process and may be required to take pictures of their own tattoo to submit to the research team.
- Patient able to send picture of tattoo via secure messaging.
Exclusion Criteria:
- Known allergies or hypersensitivity to tattoo ink.
- Personal or religious objection to medical tattooing.
- Autoimmune or skin disorders which may be worsened by medical tattooing.
- Inability to complete the required forms; however, verbal completion is adequate if recorded on the consent documents.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05248009
United States, Michigan | |
Henry Ford Health System | |
Detroit, Michigan, United States, 48202-2689 |
Principal Investigator: | Farzan Siddiqui, MD PhD | Henry Ford Health System |
Responsible Party: | Farzan Siddiqui, Senior Staff Physician, Henry Ford Health System |
ClinicalTrials.gov Identifier: | NCT05248009 |
Other Study ID Numbers: |
tattoo_schaff2021 |
First Posted: | February 21, 2022 Key Record Dates |
Last Update Posted: | June 22, 2023 |
Last Verified: | June 2023 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
radiation therapy simulation tattoo cancer semi-permanent ink |
Neoplasms, Second Primary Neoplasms |