Sector Irradiation Versus Whole Brain Irradiation for Brain Metastasis
- Conditions
- Metastatic Malignant Neoplasm to the Adult Brain
- Interventions
- Radiation: whole brain irradiationRadiation: sector irradiation
- Registration Number
- NCT01667640
- Lead Sponsor
- Medical University Innsbruck
- 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.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 50
- Solitary/singular brain metastasis
- Karnofsky Performance Index > 60%
- Stable extracranial disease /CUP
- Informed consent
- 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
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description whole brain irradiation whole brain irradiation whole brain irradiation with 40 Gy, with fixation mask, radiation of the entire brain, skull base and meninges sector irradiation sector irradiation irradiation of the resection margin plus 5 mm safety margin with 30 Gy in 5 fractions
- Primary Outcome Measures
Name Time Method local tumor control time from date of randomization until the date of first documented progression, assessed up to 36 months
- Secondary Outcome Measures
Name Time Method local progression free survival Time from randomization to the first documented tumor progressions in the resection cavity borders, assessed up to 36 months overall survival 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 distant brain metastasis 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 time to clinical deterioration Time from randomization to clinical deterioration, assessed by neurosurgeon in regular follow up visits at 3, 6, 12 and 36 months neurocognitive functions 3, 6, 12 and 36 months postoperative Neurocognitive testing by independent neuropsychologist at 3, 6, 12 and 36 months after date of randomization
steroid dosage 3, 6, 12 and 36 months postoperative Need of adjuvant steroid, assessed at 3, 6, 12 and 36 months after date of randomization
quality of life 3, 6, 12 and 36 months standardized assessment via "EORTC QLQ-C30/BN20" and the "FACT-Br" - questionary at 3, 6, 12 and 36 months after date of randomization
Trial Locations
- Locations (1)
Department of neurosurgery - Innsbruck
🇦🇹Innsbruck, Tyrol, Austria