INTRAGO-Intraoperative Radiotherapy for Glioblastoma - a Phase I/II Study - Full Text View

Purpose

Glioblastoma multiforme (GBM) is a disease with an extremely poor prognosis. Despite surgery and radiochemotherapy, the tumors are likely to grow back very quickly.

Intraoperative radiotherapy (IORT) may improve local control rates while sparing healthy tissue (Giordano et al. 2014). IORT takes place before cranioplasty directly after gross (or subtotal) tumor resection. Several past studies on IORT for GBM conducted in Japan and Spain have yielded encouraging results (Sakai et al. 1989; Matsutani et al. 1994; Fujiwara et al. 1995; Ortiz de Urbina et al. 1995).

However, the full potential of the procedure is to date largely unexplored as most previous studies used forward-scattering (electron-based) irradiation techniques, which frequently led to inadequately covered target volumes. With the advent of the spherically irradiation devices such as the Intrabeam® system (Carl Zeiss Meditec AG, Oberkochen, Germany), even complex cavities can be adequately covered with irradiation during IORT. However, there is no data on the maximum tolerated dose of IORT with low-energy X-rays as generated by this system.

The INTRAGO I/II study aims to find out which dose of a single shot of radiation, delivered intraoperatively direct after surgery, is tolerable for patients with GBM. A secondary goal of the study is to find out whether the procedure may improve survival rates.

Condition	Intervention	Phase
Glioblastoma Multiforme	Radiation: Intraoperative Radiotherapy (Applicator Surface Dose: 20-40 Gy)	Phase 1 Phase 2


Study Type:	Interventional
Study Design:	Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	INTRAGO-Intraoperative Radiotherapy for Glioblastoma - a Phase I/II Study

Resource links provided by NLM:

Genetic and Rare Diseases Information Center resources: Glioblastoma Glioma Neuroepithelioma

U.S. FDA Resources

Further study details as provided by Frederik Wenz, Universitätsmedizin Mannheim:

Primary Outcome Measures:

Maximum Tolerated Dose (MTD) [ Time Frame: 3 Months ]
The maximum tolerated (single) dose of IORT with 50 kV X-rays will be assessed using a classical "3+3" design:

The first cohort of 3 patients will receive IORT with 20 Gy (prescribed to the applicator surface). If none of these patients experiences a DLT, another three patients will be treated at the next higher dose level (30 Gy). However, should a patient experience a DLT, 3 more patients will be treated at the same dose level. The dose escalation stops if two ore more patients in a cohort of 3-6 patients experience DLT. The MTD is then defined as the dose level just below the toxic dose level.

Two types of DLT are defined:

Early DLT (≤ 3 weeks after IORT):
- wound infections / wound healing difficulties requiring surgical intervention
- IORT-related cerebral bleeding or ischemia
Delayed DLT (≤ 3 months after IORT):
- Symptomatic brain necrosis requiring surgical intervention
- Early termination of EBRT (before the envisaged dose of 60 Gy) due to radiotoxicity

Secondary Outcome Measures:

Progression Free Survival [ Time Frame: 3 Years ]
Overall Survival [ Time Frame: 3 Years ]


Enrollment:	12
Study Start Date:	March 2014
Study Completion Date:	September 2016
Primary Completion Date:	September 2016 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Intraoperative Radiotherapy Following conventional frameless neuronavigation-guided microsurgical tumor resection, patients will receive IORT with 20-40 Gy (prescribed to the applicator surface). Not later than 4 weeks, radiochemotherapy (RCT) will be initiated, consisting of a total EBRT dose of 60 Gy (delivered in fractions of 2 Gy) and concomitant chemotherapy with temozolomide (50 mg/m2/d). Four weeks after RCT, cycling chemotherapy with temozolomide (150-200mg/m2/d/cycle) will be applied.	Radiation: Intraoperative Radiotherapy (Applicator Surface Dose: 20-40 Gy)

Arms

Assigned Interventions

Experimental: Intraoperative Radiotherapy

Following conventional frameless neuronavigation-guided microsurgical tumor resection, patients will receive IORT with 20-40 Gy (prescribed to the applicator surface). Not later than 4 weeks, radiochemotherapy (RCT) will be initiated, consisting of a total EBRT dose of 60 Gy (delivered in fractions of 2 Gy) and concomitant chemotherapy with temozolomide (50 mg/m2/d). Four weeks after RCT, cycling chemotherapy with temozolomide (150-200mg/m2/d/cycle) will be applied.

Radiation: Intraoperative Radiotherapy (Applicator Surface Dose: 20-40 Gy)

Eligibility


Ages Eligible for Study:	50 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Histologically confirmed glioblastoma multiforme in frozen sections
Age ≥50 years
Karnofsky Performance Index ≥ 50%
Informed consent
Adequate birth control (e.g., oral contraceptives)

Exclusion Criteria:

Astrocytoma ≤ WHO grade III
Gliomatosis cerebri
Multifocal lesions
Infratentorial localization
Previous cranial radiation therapy (any location)
Uncontrolled intercurrent illnesses including, but not limited to, ongoing or active infection or psychiatric illness/social situations that would limit compliance with study requirements.
Contraindications for general anaesthesia
Bleeding or clotting disorders
Contraindications for MRI or CT scans
Pregnant or breastfeeding women

Contacts and Locations

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, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT02104882

Locations


Germany
Universitätsmedizin Mannheim, University of Heidelberg
Mannheim, Germany, 68167

Sponsors and Collaborators

Universitätsmedizin Mannheim

Investigators


Study Chair:	Frederik Wenz, MD	Department of Radiation Oncology, Universitätsmedizin Mannheim, University of Heidelberg
Principal Investigator:	Peter Schmiedek, MD	Department of Neurosurgery, Universitätsmedizin Mannheim, University of Heidelberg

More Information

Publications:

Giordano FA, Abo-Madyan Y, Brehmer S, Herskind C, Sperk E, Schneider F, Clausen S, Welzel G, Schmiedek P, Wenz F. Intraoperative radiotherapy (IORT)—a resurrected option for treating glioblastoma? Transl Cancer Res 2014 Jan 14. doi: 10.3978/j.issn.2218-676X.2014.01.03

Matsutani M, Nakamura O, Nagashima T, Asai A, Fujimaki T, Tanaka H, Nakamura M, Ueki K, Tanaka Y, Matsuda T. Intra-operative radiation therapy for malignant brain tumors: rationale, method, and treatment results of cerebral glioblastomas. Acta Neurochir (Wien). 1994;131(1-2):80-90.

Sakai N, Yamada H, Andoh T, Takada M, Hirata T, Funakoshi T, Doi H, Yanagawa S. [Intraoperative radiation therapy for malignant glioma]. Neurol Med Chir (Tokyo). 1989 Apr;29(4):312-8. Japanese.

Fujiwara T, Honma Y, Ogawa T, Irie K, Kuyama H, Nagao S, Takashima H, Hosokawa A, Ohkawa M, Tanabe M. Intraoperative radiotherapy for gliomas. J Neurooncol. 1995;23(1):81-6.

Ortiz de Urbina D, Santos M, Garcia-Berrocal I, Bustos JC, Samblas J, Gutierrez-Diaz JA, Delgado JM, Donckaster G, Calvo FA. Intraoperative radiation therapy in malignant glioma: early clinical results. Neurol Res. 1995 Aug;17(4):289-94.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Giordano FA, Brehmer S, Abo-Madyan Y, Welzel G, Sperk E, Keller A, Schneider F, Clausen S, Herskind C, Schmiedek P, Wenz F. INTRAGO: intraoperative radiotherapy in glioblastoma multiforme—a phase I/II dose escalation study. BMC Cancer. 2014 Dec 22;14:992. doi: 10.1186/1471-2407-14-992.


Responsible Party:	Frederik Wenz, Director, Department of Radiation Oncology, Universitätsmedizin Mannheim
ClinicalTrials.gov Identifier:	NCT02104882 History of Changes
Other Study ID Numbers:	INTRAGO-I/II
Study First Received:	March 26, 2014
Last Updated:	October 14, 2016

Keywords provided by Frederik Wenz, Universitätsmedizin Mannheim:


Glioblastoma Multiforme High-Grade Glioma Malignant Glioma IORT

Additional relevant MeSH terms:


Glioblastoma Astrocytoma Glioma Neoplasms, Neuroepithelial Neuroectodermal Tumors	Neoplasms, Germ Cell and Embryonal Neoplasms by Histologic Type Neoplasms Neoplasms, Glandular and Epithelial Neoplasms, Nerve Tissue

ClinicalTrials.gov processed this record on June 27, 2017