Pre-operative Stereotactic Radiosurgery Followed by Resection for Brain Metastases

Not Applicable

Completed

• Conditions: Malignant Neoplasm Brain

• Registration Number: NCT02514915
• Lead Sponsor: Christopher Wilke

Brief Summary

The primary goal of this research study is to determine the efficacy of giving pre-operative radiosurgery to patients pending resection of a brain metastasis.

Detailed Description

Patients who have a brain metastasis surgically resected have very high local rates of disease relapse, and so the standard of care is to give either whole brain irradiation or stereotactic radiosurgery to the resection cavity in order to prevent disease recurrence. Stereotactic radiosurgery generally offers a more favorable side effect profile than whole brain irradiation, but targeting a surgical resection bed can be a challenge, as post surgical changes make it more difficult to distinguish residual tumor from scar, and much of the dose ends up being focused on the center of the resection cavity, where there are no substantial tumor cells.

Study Timeline

• Study First Submitted: 2015-07-30
• Study First Submitted QC: 2015-07-31
• Study First Posted: 2015-08-04
• Study Start: 2016-12-01
• Primary Completion: 2021-07-22
• Study Completion: 2021-07-22
• Results First Submitted: 2025-03-25
• Status Verified: 2025-06
• Results First Submitted QC: 2025-06-06
• Last Update Submitted: 2025-06-06
• Results First Posted: 2025-06-26
• Last Update Posted: 2025-06-26

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 24

Inclusion Criteria

• Life expectancy of at least 12 weeks
• Karnofsky performance status of at least 50
• No contraindications to MRI scanning with intravenous contrast.
• MRI scan consistent with brain metastasis as per radiology report.
• Target lesion must measure at least 15 mm in at least one dimension, and no more than 4 cm in any dimension.
• Patients must have an extra-cranial primary tumor diagnosis.
• Patients will have no more than 4 distinct lesions within the brain. At least 1 lesion has been recommended for surgical removal based on size, symptomology, or regional mass effect on the brain.
• Additional lesions will each be treated with stereotactic radiosurgery.
• Patients with a documented symptomatic lesion size smaller than 3cm requiring clinical surgical resection
• Must be aware of the neoplastic nature of his/her disease and willingly provide written, informed consent after being informed of the procedure to be followed, the experimental nature of the therapy, alternatives, potential benefits, side-effects, risks and discomforts

Exclusion Criteria

• Primary tumor histology of lymphoma, leukemia, multiple myeloma or germ cell tumor. Moribund status or status epilepticus.
• Supratentorial mass effect with greater than 5 mm of midline shift or hydrocephalus. Infratentorial mass effect with fourth ventricle effacement or hydrocephalus.
• More than four additional diagnosed brain metastases.
• Contraindication to general anesthesia.
• Adjacent tumor location to optic apparatus or brainstem, precluding achievement of meaningful dose with SRS.
• Primary brain tumor.
• Contraindication to MRI scans or intravenous contrast.
• Pregnant and breast-feeding females.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Primary Outcome Measures

Name	Time	Method
Local Control Rate (LCR) at 6 Months	At 6 months	The probability that patients experience a change in size of a tumor (measured by the amount of space taken up by the tumor). Tumor volume was measured at 6 months compared to the tumor volume at the start of radiotherapy.
Local Control Rate (LCR) at 12 Months	At 12 months	The probability that patients experience a change in size of a tumor (measured by the amount of space taken up by the tumor). Tumor volume was measured at 12 months compared to the tumor volume at the start of radiotherapy.
Local Control Rate (LCR) at 24 Months	At 24 months	The probability that patients experience a change in size of a tumor (measured by the amount of space taken up by the tumor). Tumor volume was measured at 24 months compared to the tumor volume at the start of radiotherapy.

Secondary Outcome Measures

Name	Time	Method
6-month Overall Survival (OS)	At 6 months	The probability of patients being alive at 6 months after the beginning of treatment.
12-month Overall Survival (OS)	At 12 months	The probability of patients being alive at 12 months after the beginning of treatment.
24-month Overall Survival (OS)	At 24 months	The probability of patients being alive at 24 months after the beginning of treatment.
Distant Intracranial Failure	At 24 months	The probability of new brain metastases at 24 months identified via magnetic resonance imaging.
Health Related Quality of Life (HRQL) - FACT - BR (FACT - BRAIN)	At 24 months (3-month window)	The Functional Assessment of Cancer Therapy - Brain (FACT-Br) (23 questions that assess brain-tumor related issues) including the FACT-General (FACT-G), a core questionnaire used to determine the more general domains of QOL among all cancer patients was administered. This assessment is a 50 item, self-administered questionnaire used to assess Quality of Life, including, Physical Well-Being, Social/Family Well-Being, Emotional Well-Being, and Functional Well-Being. Subscale scores range from 0-4. FACT-G = (PWB - 7 items, score range 0-28) + (SWB - 7 items, score range 0-28) + (EWB - 6 items, score 0-24) + (FWB - 7 items, 0-28). The assessment takes 10-15 minutes to completed and is scored using a 5-point Likert-type scale. FACT Gen Scores range from 0-108. Brain (FACT-Br) Scores range from 0-92 (23 questions with 0-4 score). Thus, total assessments combine scores range from 0-200. Higher total scores indicating better quality of life.

Trial Locations

Locations (1)

UPMC Shadyside Radiation Oncology Department; 🇺🇸 Pittsburgh, Pennsylvania, United States