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Stereotactic Radiosurgery Compared to Observation in Treating Patients With Brain Metastases

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ClinicalTrials.gov Identifier: NCT00950001
Recruitment Status : Active, not recruiting
First Posted : July 31, 2009
Last Update Posted : May 31, 2019
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
M.D. Anderson Cancer Center

Brief Summary:
This randomized phase III trial studies stereotactic radiosurgery to see how well it works compared to clinical observation after surgery in treating patients with brain metastases. Stereotactic radiosurgery, a type of radiation therapy, may be able to send x-rays directly to the tumor and cause less damage to normal tissue.

Condition or disease Intervention/treatment Phase
Metastatic Malignant Neoplasm in the Brain Radiation: Stereotactic Radiosurgery Phase 3

Detailed Description:

PRIMARY OBJECTIVES:

I. To evaluate benefit of post-surgical stereotactic radiosurgery (SRS) on the resection bed in providing 6 month local control (decreasing the risk of local tumor recurrence) when compared to surgical resection alone.

SECONDARY OBJECTIVES:

I. Overall survival, development of distant brain metastases and complications related to treatment.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients undergo stereotactic radiosurgery to the surgical cavity within 30 days of the craniotomy.

ARM II: Patients undergo clinical observation after craniotomy.

After completion of study treatment, patients are followed up at 5-8 weeks, every 6-9 weeks for 1 year, every 3-4 months for 1 year, and then every 6 months thereafter.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 132 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Efficacy of Post-Surgical Stereotactic Radiosurgery for Metastatic Brain Disease: A Randomized Trial
Actual Study Start Date : August 13, 2009
Estimated Primary Completion Date : August 31, 2019
Estimated Study Completion Date : August 31, 2020

Arm Intervention/treatment
Experimental: Arm I (SRS)
Patients undergo stereotactic radiosurgery to the surgical cavity within 30 days of the craniotomy.
Radiation: Stereotactic Radiosurgery
Undergo SRS
Other Names:
  • Stereotactic External Beam Irradiation
  • stereotactic external-beam radiation therapy
  • stereotactic radiation therapy
  • Stereotactic Radiotherapy
  • stereotaxic radiation therapy
  • stereotaxic radiosurgery

No Intervention: Arm II (observation)
Patients undergo clinical observation after craniotomy.



Primary Outcome Measures :
  1. Time to local recurrence [ Time Frame: 6 months ]
    A univariate test between groups will be conducted using a log rank test of Kaplan-Meier survival estimates and multivariate analyses will be conducted via the Cox proportional hazards model. The hazard ratio comparing each arm will be computed for each endpoint with and without adjustment for other covariates. Confidence intervals (95%) will be computed for the hazard ratio estimates. The proportion of patients experiencing neurological complications will be computed via univariate and multivariate logistic regression analysis.


Secondary Outcome Measures :
  1. Overall survival [ Time Frame: Up to 8 years ]
    A univariate test between groups will be conducted using a log rank test of Kaplan-Meier survival estimates and multivariate analyses will be conducted via the Cox proportional hazards model. The hazard ratio comparing each arm will be computed for each endpoint with and without adjustment for other covariates. Confidence intervals (95%) will be computed for the hazard ratio estimates.

  2. Development of distant brain metastases [ Time Frame: Up to 8 years ]
    A univariate test between groups will be conducted using a log rank test of Kaplan-Meier survival estimates and multivariate analyses will be conducted via the Cox proportional hazards model. The hazard ratio comparing each arm will be computed for each endpoint with and without adjustment for other covariates. Confidence intervals (95%) will be computed for the hazard ratio estimates.

  3. Incidence of complications related to treatment [ Time Frame: Up to 8 years ]
    The proportions of patients experiencing neurological complications will be computed via univariate and multivariate logistic regression analysis. The proportion of complications resulting in prolongation of hospital stay will also be computed. The odds ratios comparing both arms will be computed with and without adjustment for other covariates. Confidence intervals (95%) will be computed for the odds ratio estimates.

  4. Proportion of patients experiencing neurological complications [ Time Frame: Up to 8 years ]
    Computed via univariate and multivariate logistic regression analysis.

  5. Proportion of complications resulting in prolongation of hospital stay [ Time Frame: Up to 8 years ]
    Will be computed.

  6. Time to first neurological complication [ Time Frame: Up to 8 years ]
    A univariate test between groups will be conducted using a log rank test of Kaplan-Meier survival estimates and multivariate analyses will be conducted via the Cox proportional hazards model. The hazard ratio comparing each arm will be computed for each endpoint with and without adjustment for other covariates. Confidence intervals (95%) will be computed for the hazard ratio estimates.



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Ages Eligible for Study:   4 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must have 3 or fewer newly diagnosed metastatic lesions in the brain with a complete resection of at least one lesion as determined by the study neuroradiologist
  • The resection cavity must have a maximum diameter of less than or equal to 4 cm; this criteria will be determined by the study radiologist)
  • Additional unresected brain metastases (up to 2) must have a maximum diameter of less than or equal to 3 cm
  • Patients must be considered candidates for SRS within 30 days of surgical resection
  • Patients must have a Karnofsky performance scores (KPS) of at least 70 at the first postoperative visit; patients under 18 years of age must have a Lansky performance score of at least 70
  • Patients must be able to undergo an magnetic resonance imaging (MRI) scan
  • Patients must agree to randomization as documented by signing the Institutional Review Board (IRB) approved consent form

Exclusion Criteria:

  • Patients who have received prior radiation therapy to the brain for any reason
  • There is radiographic evidence of leptomeningeal disease prior to study entry
  • The primary tumor is small-cell lung cancer, lymphoma, leukemia, or multiple myeloma
  • For females, if they are pregnant or breast-feeding (The exclusion is made because gadolinium may be teratogenic in pregnancy)

Information from the National Library of Medicine

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): NCT00950001


Locations
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United States, Texas
M D Anderson Cancer Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
M.D. Anderson Cancer Center
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Erik P Sulman M.D. Anderson Cancer Center

Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT00950001     History of Changes
Other Study ID Numbers: 2009-0381
NCI-2011-00542 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
2009-0381 ( Other Identifier: M D Anderson Cancer Center )
P30CA016672 ( U.S. NIH Grant/Contract )
First Posted: July 31, 2009    Key Record Dates
Last Update Posted: May 31, 2019
Last Verified: May 2019

Additional relevant MeSH terms:
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Neoplasms
Neoplasms, Second Primary
Brain Neoplasms
Central Nervous System Neoplasms
Nervous System Neoplasms
Neoplasms by Site
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases