Clinical trial NCT01667640: Sector Irradiation Versus Whole Brain Irradiation for Brain Metastasis
Official title: Sector Irradiation Versus Whole Brain Irradiation After Resection of Singular or Solitary Brain Metastasis - a Prospective Randomized Monocentric Trial
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Metastatic Malignant Neoplasm to the Adult Brain
Keywords: Brain metastases
radiation
sector
singular
solitary
neurocognition
Lead sponsor: Medical University Innsbruck
Sponsor class: OTHER
Collaborators: name: Marcel Seiz-Rosenhagen MD, PD
name: Meinhard Nevinny-Stickel MD, Prof.
name: Christian F Freyschlag MD
name: Günther Stockhammer MD, Prof.
name: Bernhard Holzner MD, Doz
name: Johannes Giesinger Mag
name: Margarete Delazer MD, Prof.
name: Thomas Bodner MD, MSc
name: Claudius Thomé MD, Prof.
First posted: 2012-08-17
Enrollment: 50
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Microneurosurgical resection of intracerebral metastases leads to prolonged survival and relief of symptoms in selected patients.

To minimize the risk of intracranial recurrence whole brain irradiation has been established as standard adjuvant treatment in those patients. Sector irradiation resembles a brain - tissue - sparing method by focusing the irradiation in the area of the tumor bed and a surrounding 1mm security margin.

The aim of this study is to investigate whether adjuvant "sector""-irradiation following microsurgical resection is equal to adjuvant whole brain irradiation in terms of local control and superior to in terms of quality of life and neurocognitive deficits in a prospective randomized trial.

Detailed description: Microneurosurgical resection of intracerebral metastases leads to prolonged survival and relief of symptoms in selected patients. Traditionally whole-brain irradiation is the treatment of choice following surgical resection. Whole brain irradiation has been the standard approach to minimize the risk of intracranial recurrence following resection of brain metastases. Almost 2 decades ago, Patchell et al. established the superiority of resection of solitary metastases followed by whole brain irradiation compared with whole brain irradiation alone with regard to survival, local control, and length of functional independence. A following study by the same group failed to show a survival advantage for the addition of whole brain irradiation compared to surgical resection alone in patients with a solitary intracranial metastasis, although the likelihood of local and distant recurrence and death from neurological causes were significantly reduced by whole brain irradiation. Due to potential delayed neurocognitive effects associated with whole brain irradiation, investigators have evaluated the use of partial brain irradiation in the form of stereotactic radiosurgery instead of whole brain irradiation after resection of brain metastases. They showed that despite whole brain irradiation means superior control of brain recurrence in sites other than the resection bed, stereotactic radiosurgery after resection resulted in equivalent survival times and neurological preservation. In a retrospective series of 52 patients Karlovits et al. could show that stereotactic radiosurgery following surgical resection leads to equal local control compared to standard whole brain irradiation.

Study objective

The aim of this study is to investigate whether adjuvant "sector" -irradiation following microsurgical resection is equal to adjuvant whole brain irradiation in terms of local control and superior to in terms of quality of life and neurocognitive deficits in a prospective randomized trial.

Hypothesis

1. Sector irradiation is equal to whole-brain irradiation in local tumor control after 3, 6, 12 and 36 months and
2. Sector irradiation" is superior to whole-brain irradiation in terms of quality of life and neurocognitive function

Patients and Methods

Patients with a single brain metastasis amenable to surgical resection fulfilling the inclusion criteria will be consecutively enrolled in this study. After microsurgical complete resection documented by early postoperative MRI within 72 hours and histological proven brain metastasis patients will be randomized in arm A or B. Radiotherapy will start after 14th postoperative day within 3 weeks postoperatively. Study arm A means postoperative sector irradiation (30Gy), study arm B includes standard whole brain radiotherapy (40Gy). Follow up MRI will be every 3 months. Neurocognitive evaluation will be performed before radiotherapy and 6 and 12 months postoperatively. In case of local recurrence or developing further metastases a cross over to whole brain radiotherapy or focal irradiation is possible.

Eligibility criteria: Inclusion Criteria:

* Solitary/singular brain metastasis
* Karnofsky Performance Index \> 60%
* Stable extracranial disease /CUP
* Informed consent

Exclusion Criteria:

* Small cell lung cancer
* Squamous cell lung cancer
* HER2-negative breast cancer
* Deep-seated location (e.g. basal ganglia)
* Expected surgery related neurological deficit
* Tumor diameter \< 3cm

Primary outcomes:
measure: local tumor control
timeFrame: time from date of randomization until the date of first documented progression, assessed up to 36 months
Secondary outcomes:
measure: distant brain metastasis
timeFrame: Time from date of randomization until the date of first documented progression elsewhere than the resection cavity, assessed at 3, 6, 12 and 36 months
measure: time to clinical deterioration
timeFrame: Time from randomization to clinical deterioration, assessed by neurosurgeon in regular follow up visits at 3, 6, 12 and 36 months
measure: local progression free survival
timeFrame: Time from randomization to the first documented tumor progressions in the resection cavity borders, assessed up to 36 months
measure: quality of life
timeFrame: 3, 6, 12 and 36 months
measure: neurocognitive functions
timeFrame: 3, 6, 12 and 36 months postoperative
measure: steroid dosage
timeFrame: 3, 6, 12 and 36 months postoperative
measure: overall survival
timeFrame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 36 months
Other outcomes:
Locations:
city: Innsbruck
country: Austria
facility: Department of neurosurgery - Innsbruck
state: Tyrol
Study officials:
affiliation: Department of Neurosurgery, Medical University Innsbruck
name: Marcel Seiz-Rosenhagen, MD, PD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Kerschbaumer J, Pinggera D, Holzner B, Delazer M, Bodner T, Karner E, Dostal L, Kvitsaridze I, Minasch D, Thome C, Seiz-Rosenhagen M, Nevinny-Stickel M, Freyschlag CF. Sector Irradiation vs. Whole Brain Irradiation After Resection of Singular Brain Metastasis-A Prospective Randomized Monocentric Trial. Front Oncol. 2020 Nov 24;10:591884. doi: 10.3389/fonc.2020.591884. eCollection 2020.