Radiosurgical Hypophysectomy for Bone Metasteses Pain
- Conditions
- Bone Metastases
- Interventions
- Radiation: radiosurgical hypophysectomy
- Registration Number
- NCT03377517
- Brief Summary
This research is being done to see if a delivery of a single high dose of radiation therapy to a small area of the pituitary gland and pituitary stalk in a highly precise manner may be helpful in reducing intractable pain from bone metastases.
- Detailed Description
Although not currently standard of care, small series suggest both safety and efficacy of radiosurgical hypophysectomy in reducing cancer pain from bone metastases. In spite of the demonstrated feasibility in meeting normal tissue constraints and preliminary data suggestive of both safety and efficacy, radiosurgical hypophysectomy is rarely performed in clinical practice, and many radiation oncologists are not even aware of its potential to reduce intractable cancer pain. This is likely because, to date, well-designed prospective studies have not been performed to further explore both the safety and efficacy of the intervention. This single arm pilot study is designed to fill that void. If successful, the investigators plan to utilize the data to support the proposal of a larger scale follow-up clinical trial.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 16
- Cytologic proof of malignancy
- Radiographic evidence of bone metastases
- Intractable pain uncontrolled by opioids, medical management, injections/ablation or surgical intervention that would be difficult to address with conventional radiation therapy or other standard options and is limiting the patient's function and quality of life. Intractable pain will be defined as a visual analogue score of at least 4.
- Definitive radiographic progression of osseous and/or visceral metastases on standard staging scans (CT, MRI, bone scan, PET scan or any other standard of care imaging) performed within the last 3 months in spite of standard oncologic interventions and/or inability to tolerate standard oncologic interventions
- Life expectancy at least 4 weeks
- Age≥ 18 years
- Patients of childbearing potential (male or female) must practice adequate contraception due to possible harmful effects of radiation therapy on an unborn child
- Patient must have the ability to understand and the willingness to sign a written informed consent document
- All patients must be informed of the investigational nature of this study and must be given written informed consent in accordance with institutional and federal guidelines
- Prior brain radiation
- Patients must not have a serious medical or psychiatric illness that would, in the opinion of the treating physician prevent informed consent or completion of protocol treatment
- Isolated localized pain amenable to focal radiation therapy, or pain well controlled by opioids, medical management, injections/ablation or surgical intervention
- Malignancies being managed with curative intent
- Life expectancy <4 weeks
- The tumor amenable to curative management
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description ResearchTreatment Plan radiosurgical hypophysectomy Patients will be treated to a dose of 150 Gy in a single fraction. All patients will undergo CT simulation with 1 mm slices as well as MRI simulation including at least high resolution 1 mm slice T1 weighted MRI. They will be treated in a supine position using an aquaplast mask system for immobilization.
- Primary Outcome Measures
Name Time Method Change in Intensity of Bone Pain 4 weeks To estimate the rate of clinically meaningful decrease in diffuse osseous pain following radiosurgical hypophysectomy at 4 weeks following completion of radiosurgical hypophysectomy
- Secondary Outcome Measures
Name Time Method Rate of change of disease spread Up to 100 weeks following completion of radiosurgical hypophysectomy To estimate the rate of clinically meaningful decrease in diffuse osseous pain following radiosurgical hypophysectomy
Rate of Change of Quality of Life Up to 100 weeks following completion of radiosurgical hypophysectomy To estimate the rate of clinically meaningful increase in patient reported quality of life following radiosurgical hypophysectomy
Rate of change in opioid use Up to 100 weeks following completion of radiosurgical hypophysectomy To estimate the rate of reduction in opioid utilization following radiosurgical hypophysectomy
Rate of biochemical endocrinopathy Up to 100 weeks following completion of radiosurgical hypophysectomy To estimate the rate of biochemical endocrinopathy following radiosurgical hypophysectomy
Rate of change of optic nueropathy Up to 100 weeks following completion of radiosurgical hypophysectomy To estimate the risk of radiation induced optic neuropathy following radiosurgical hypophysectomy
Rate of change of neurologic toxicity Up to 100 weeks following completion of radiosurgical hypophysectomy To estimate the radiation-associated acute and long term neurologic toxicity of radiosurgical hypophysectomy
Rate of change of insipidus diabetes Up to 100 weeks following completion of radiosurgical hypophysectomy To estimate the rate of diabetes insipidus following radiosurgical hypophysectomy
Rate of change in costs Up to 100 weeks following completion of radiosurgical hypophysectomy To estimate the cost effectiveness of radiosurgical hypophysectomy
Rate of change of cortisol Up to 100 weeks following completion of radiosurgical hypophysectomy To estimate the relationship between pain response and cortisol levels
Rate of change of pain with respect to hormones Up to 100 weeks following completion of radiosurgical hypophysectomy To estimate the rate of pain response in hormonally active and non-hormonally active tumors
Rate of change of pain with respect to morphine Up to 100 weeks following completion of radiosurgical hypophysectomy To estimate the rate of pain response in morphine sensitive and morphine insensitive tumors
Trial Locations
- Locations (1)
The Sidney Kimmel Comprehsensive Cancer Center at Johns Hopkins
🇺🇸Baltimore, Maryland, United States