Image-guided and Intensity-modulated Radiotherapy Versus External Beam Radiotherapy for Patients With Spine Metastases

Study Overview
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Brief Summary
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The aim of this explorative trial is to verify the comparability of a fractionated intensity modulated radiotherapy with a conventional radiotherapy related to quality of life on the one hand and to evaluate toxicity, re-calcification and stability of vertebral body as well as pain relief and local response for palliative patients with painful spinal bone metastases on the other hand. This is a single-center, prospective randomized controlled trial with parallel-group design to determine the quality of life after RT in patients with spinal bone metastases. Two different techniques were evaluated: intensity modulated radiotherapy (IMRT) and fractionated conventional external beam RT with 10×3 Gy each. Experimental intervention: IMRT 10 x 3 Gy Control intervention: 3D-RT 10 x 3 Gy

Detailed Description
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The aim of this explorative trial is to verify the comparability of a fractionated intensity modulated radiotherapy with a conventional radiotherapy related to quality of life on the one hand and to evaluate toxicity, re-calcification and stability of vertebral body as well as pain relief and local response for palliative patients with painful spinal bone metastases on the other hand. This is a single-center, prospective randomized controlled trial with parallel-group design to determine the quality of life after RT in patients with spinal bone metastases. Two different techniques were evaluated: intensity modulated radiotherapy (IMRT) and fractionated conventional external beam RT with 10×3 Gy each. Experimental intervention: IMRT 10 x 3 Gy Control intervention: 3D-RT 10 x 3 Gy After the baseline measurements have been recorded, the patients will be randomly assigned to one of the two groups: IMRT 10×3 Gy (n = 30) or fractionated conventional 3D-RT 10×3 Gy (n = 30). The RT will be applied daily (mondy to Friday). Follow-up per patient: The target parameters will be measured and recorded at baseline, at the end of RT (t1), and at 12 weeks (t2) and 6 months (t3) after the end of the irradiation period.

Official Title
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Image-guided and Intensity-modulated Radiotherapy Versus External Beam Radiotherapy for Patients With Spine Metastases

Conditions
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Vertebral Bony Metastases

Intervention / Treatment
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* Radiation: IMRT
* Radiation: fractionated RT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with a histologically confirmed tumor diagnosis and with secondary diagnosed solitary/multiple spinal bone metastases Indication for RT of the spinal bone metastases Age of between 18 and 85 years Karnofsky index of at least 50 Signed declaration of informed consent Exclusion Criteria: Lymphoma Significant neurological or psychiatric disorders, including dementia and epileptic seizures Previous RT at the current irradiation site Other severe disorders that in the judgment of the study director may prevent the patient's participation in the study Lacking or diminished legal capacity Any medical of psychological condition that the study director considers a preventive factor for the patient's ability to complete the study or to adequately understand the scope of the study and to give his or her consent.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: A<br>intensity modulated radiotherapy (IMRT) 10 x 3 Gy | Radiation: IMRT<br>* Intensity modulated Raiotherapy (IMRT) of the involved spinal bone metastasis<br>|
| Active Comparator: B<br>fractionated conventional external beam RT 10×3 Gy | Radiation: fractionated RT<br>* external beam Radiotherapy of the involved spinal bone metastasis<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| quality of life | improvement of more than 10% according to the EORTC BM22 questionaire measured at the 3-months-time-point after the end of RT (t2). | 3-months-time-point after the end of RT | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| bone density | bone density is assessed 12 weeks post completion of radiotherapy using follow-up CT scan of the spine | 12 weeks post completion radiotherapy | 
| pain reduction | pain is evaluated using the VAS pain scale (0-100 points) at completion and 12/ 24 weeks post completion of radiation | end of treatment, 12 and 24 weeks post completion of radiotherapy | 
| Fatigue | Fatigue is assessed using the EORTC FA13 questionnaire | 12 and 24 weeks post completion of therapy | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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bony metastases, palliative radiotherapy