FMISO-PET in Brain Tumors and SCS Effect
- Conditions
- Malignant Glioma
- Interventions
- Procedure: PET without SCSRadiation: RadiotherapyDevice: SCSProcedure: PET without/with SCS
- Registration Number
- NCT01868906
- Lead Sponsor
- Bernardino Clavo, MD, PhD
- Brief Summary
The aim of this study is to assess, with 18F-FMISO PET, hypoxia in high grade gliomas and changes by spinal cord stimulation in a subset of patients. Additionally, the potential correlation with pathological, imaging and clinical parameters will be analyzed.
- Detailed Description
Tumour ischaemia-hypoxia decreases the efficacy of radio-chemotherapy. Polarographic probe (and some 18F-FMISO-PET) studies have demonstrated prognostic value. Additionally hypoxia modification may increase survival. However, in high grade gliomas (HGG) there are not well established methods to evaluate and modify tumor hypoxia. We have previously described how spinal cord stimulation (SCS) can modify oxygenation, blood flow and metabolism in malignant gliomas. The aim of this study is to assess with 18F-FMISO PET: hypoxia in HGG and changes by spinal cord stimulation in a subset of patients. Additionally, the potential correlation with pathological, imaging and clinical parameters will be analyzed.
18F-FMISO PET will be performed in 20 patients with diagnosis of HGG: after surgery/biopsy and before radical treatment with 3D radiotherapy and temozolomide. A subset of 10 patients undergo two studies with 18F- FMISO-PET (one with SCS "off" and one with SCS "on"). In these patients, SCS will be connected from 1 hour before to 1 hour after each radiotherapy session, and in the day-time during the days of adjuvant temozolomide.
18F-FMISO PET results will not be taking into account for patient management. Patients will be followed at least until the end of adjuvant temozolomide (6 months after the end of concurrent radiochemotherapy).
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 6
- Patients with pathologically confirmed (first presentation or relapsed) high grade glioma (Grade III or Grade IV according WHO criteria) proposed for radical treatment with 3D radiotherapy and temozolomide.
- Patients 18-75 years old.
- Karnofsky >= 60% and ECOG =< 2.
- Signed informed consent.
- Clinical or psychological contraindications to fly (if 18F-FMISO-PET is realized in Madrid) or to SCS-placement (only for this subset).
- Pregnant or breastfeeding women and women of fertile age who are not using a safe contraceptive method or do not intend to use one during the trial. Safe contraceptive methods are oral or parenteral contraceptive treatments or barrier methods: masculine or feminine condom, diaphragm and/or intrauterine device (IUD) or withdrawal over the course of the study.
- Serious co-existing or concurrent illness, including any of the following: uncontrolled or severe infection, heart, liver or kidney disease
- Lung thromboembolism.
- Another malignancy in the last 5 years other than basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix.
- Patients with life expectancy <3 months.
- Patients with any of the following: creatinine > 2 mg/dl, neutrophils <1.5 * 10^9/L, platelets <100 * 10^9/L or hemoglobin <8.5 g/dL.
- Contraindications to receive radiotherapy or chemotherapy Clinical or psychological contraindications for placement of spinal cord stimulation devices (only for that specific subset of patients).
- Patients who are unable or unwilling to meet the protocol study.
- Patients who do not meet all the inclusion criteria.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm-B: 18F-FMISO-PET without/with SCS PET without SCS Two 18F-FMISO-PET studies for assessment of tumor hypoxia before radiotherapy and Temozolomide: one "without" and one "with" spinal cord stimulation Arm-B: 18F-FMISO-PET without/with SCS PET without/with SCS Two 18F-FMISO-PET studies for assessment of tumor hypoxia before radiotherapy and Temozolomide: one "without" and one "with" spinal cord stimulation Arm-A: 18F-FMISO-PET without SCS 18F-FMISO One 18F-FMISO-PET study for assessment of tumor hypoxia before radiotherapy and Temozolomide, without spinal cord stimulation. Arm-A: 18F-FMISO-PET without SCS PET without SCS One 18F-FMISO-PET study for assessment of tumor hypoxia before radiotherapy and Temozolomide, without spinal cord stimulation. Arm-A: 18F-FMISO-PET without SCS Radiotherapy One 18F-FMISO-PET study for assessment of tumor hypoxia before radiotherapy and Temozolomide, without spinal cord stimulation. Arm-B: 18F-FMISO-PET without/with SCS SCS Two 18F-FMISO-PET studies for assessment of tumor hypoxia before radiotherapy and Temozolomide: one "without" and one "with" spinal cord stimulation Arm-B: 18F-FMISO-PET without/with SCS Radiotherapy Two 18F-FMISO-PET studies for assessment of tumor hypoxia before radiotherapy and Temozolomide: one "without" and one "with" spinal cord stimulation Arm-B: 18F-FMISO-PET without/with SCS 18F-FMISO Two 18F-FMISO-PET studies for assessment of tumor hypoxia before radiotherapy and Temozolomide: one "without" and one "with" spinal cord stimulation Arm-A: 18F-FMISO-PET without SCS Temozolomide One 18F-FMISO-PET study for assessment of tumor hypoxia before radiotherapy and Temozolomide, without spinal cord stimulation. Arm-B: 18F-FMISO-PET without/with SCS Temozolomide Two 18F-FMISO-PET studies for assessment of tumor hypoxia before radiotherapy and Temozolomide: one "without" and one "with" spinal cord stimulation
- Primary Outcome Measures
Name Time Method Tumor hypoxia measurement using 18F-FMISO-PET (hypoxic volume and tumor/muscle ratio). Baseline measurement. 18F-FMISO-PET between 1 and 3 weeks before the commencement of radio-chemotherapy Tumor hypoxia will be measured in 20 patients with HGG using 18F-FMISO-PET: after biopsy or surgery and before the commencement of radio-chemotherapy. It will be assessed the prevalence and extent of significant hypoxia in HGG.
Change from baseline tumor hypoxia using 18F-FMISO-PET (hypoxic volume and tumor/muscle ratio) during SCS. 2nd 18F-FMISO-PET between 1 and 7 days after the 1st 18F-FMISO-PET A subset of 10 patients will undergo a second 18F-FMISO-PET study during spinal cord stimulation to evaluate changes by SCS between 1 and 7 days after the first 18F-FMISO-PET study (and before the commencement of radio-chemotherapy).
- Secondary Outcome Measures
Name Time Method Correlation between 18F-FMISO-PET values and pathological tumor parameters Week 0 (at the commencement of radio-chemotherapy). To analyze the correlation of 18F-FMISO-PET with histological parameters and tumor expression of: CD31 (vascular density), VEGF (vascular endothelial growth factor) and VEGFR (angiogenesis), EGFR (epidermal growth factor receptor), Ki-67 (proliferation index) and hypoxic markers
Correlation with Karnofsky scale. At 0, 2 and 9 months after the commencement of the radio-chemotherapy. To analyze the correlation with performance status using the Karnofsky scale.
Correlation with the ECOG (Eastern Cooperative Oncology Group) performance status scale At 0, 2 and 9 months after the commencement of the radio-chemotherapy To analyze the correlation with performance status using the ECOG (WHO) scale.
Correlation with the Quality of Life Questionnaire QLQ-C30 (EORTC) At 0, 2 and 9 months after the commencement of the radio-chemotherapy. To analyze the correlation with quality of life using the QLQ-C30 (EORTC) questionnaire.
Overall survival. At 9 months after the commencement of the radio-chemotherapy. To analyze the correlation with overall survival.
Radiological response to treatment 9 months after the commencement of radio-chemotherapy To analyze the correlation between 18F-FMISO-PET values and radiological response to treatment
Radiological location of tumor relapse or progression 9 months after the commencement of radio-chemotherapy To analyze the correlation between 18F-FMISO-PET values and the radiological location of tumor relapse or progression
Trial Locations
- Locations (2)
Dr. Negrin University Hospital
🇪🇸Las Palmas, Spain
Instituto Tecnologico Servicios Sanitarios, in MD Anderson Cancer Center, Madrid
🇪🇸Madrid, Spain