Hippocampal Sparing Whole Brain Radiotherapy vs Conventional Whole Brain Radiotherapy in Patients With Brain Metastases (HIPPO)

A Randomized Phase II Trial of Hippocampal Sparing Versus Conventional Whole Brain Radiotherapy After Surgical Resection or Radiosurgery in Favourable Prognosis Patients With 1-10 Brain Metastases

The purpose of this study is to evaluate whether sparing the hippocampi during whole brain radiotherapy following neurosurgery or stereotactic radiosurgery in patients with brain metastases from a systemic tumour helps preserve brain function.

Study Overview

• Status: Completed
• Conditions: Brain Metastases
• Intervention / Treatment: Radiation: Hippocampal sparing whole brain radiotherapy; Radiation: Conventional whole brain radiotherapy

• Study Type: Interventional
• Enrollment (Actual): 23
• Phase: Phase 2

Contacts and Locations

Study Locations

• United Kingdom
  • Cambridge, United Kingdom
    • Addenbrooke's Hospital
  • Guildford, United Kingdom
    • Royal Surrey County Hospital
  • London, United Kingdom, W6 8RF
    • Charing Cross Hospital
  • Manchester, United Kingdom, M20 4BX
    • The Christie NHS Foundation Trust
  • Nottingham, United Kingdom
    • Nottingham University Hospitals
  • Romford, United Kingdom
    • Barking, Havering and Redbridge University Hospitals NHS Trust
  • Greater London
    • Birmingham, Greater London, United Kingdom, N4 3SL
      • University Hospitals Birmingham NHS Foundation Trust

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (ADULT, OLDER_ADULT, CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age ≥ 16 years
• Karnofsky Performance Status (KPS) ≥ 70
• Brain metastases from systemic malignancy which has been histologically confirmed (from the primary or any metastatic site)
• In total, at most 10 distinct brain metastases based on MRI imaging with contrast at any prior time-points

• Each of the brain metastases to have been treated by complete or incomplete surgical excision or by SRS in line with UK SRS commissioning guidelines which in addition for STS treated patients means:

  • Patient selection for SRS by the appropriate MDT(s),
  • No pressure symptoms which would be best relieved by surgery,
  • Life expectancy from extracranial disease greater than 6 months,
  • Gross tumour volume at time of SRS ≤ 20 cc.

• Ability to comply with the following timelines:

  • Randomisation 1 - 4 weeks (+/- 3 days, but only acceptable if accounting for logistical issues) after neurosurgery or last SRS fraction,
  • Start of WBRT or HS-WBRT 4 - 6 weeks (+ 3 days, but only acceptable if accounting for logistical or planning treatment issues) after neurosurgery or last SRS fraction.
• Ability to complete the NCF test battery (including ability to speak English).
• Willing and able to give consent and to comply with treatment and follow up schedule.

Exclusion Criteria:

• Metastases from small cell carcinoma from any site, haematological malignancy, or central nervous system malignancy,
• Leptomeningeal metastases,
• Contraindication to MRI imaging with contrast,
• Prior radiotherapy to the brain (apart from a single course of SRS for brain metastases completed within 1-4 weeks (+/- 3 days) of randomisation and within 4-6 weeks (+3 days) of start of the HIPPO trial treatment),

• Prior neurosurgery for brain metastases (apart from a single operation within 1-4 weeks (+/- 3 days) of randomisation and within 4-6 weeks (+3 days) of start of HIPPO trial treatment), except that one or more earlier operations not immediately preceding HIPPO trial entry will be allowed if:

  • there is no evidence of residual tumour at the resection site on contrast MRI imaging, or
  • residual tumour at the resection site has been treated by SRS immediately prior to entering the HIPPO trial,
• One or more metastases currently or previously within 5 mm of either hippocampus,
• One or more metastases within the brainstem,
• One or more SRS treated metastases in close proximity to critical normal organs, unless the local investigator is satisfied that the dose already received by the critical organ allows for subsequent delivery of the HIPPO protocol radiotherapy doses,
• Disease specific graded prognostic assessment (DS-GPA) score ≤ 1.0 for any of the histologies for which DS-GPA has been defined,
• Past medical history of dementia which is thought to be unrelated to the brain metastases,
• Women of childbearing potential who are known to be pregnant, or are unwilling to use an acceptable method of contraception from the time of informed consent until completion of the course of radiotherapy.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Hippocampal sparing whole brain RT; 30 Gy in 10 fractions hippocampal sparing whole brain radiotherapy will be administered by Helical Tomotherapy, IMRT, or VMAT	Radiation: Hippocampal sparing whole brain radiotherapy; 30 Gy in 10 fractions hippocampal sparing whole brain radiotherapy will be administered by Helical Tomotherapy, IMRT, or VMAT
Active Comparator: Control: Conventional whole brain RT; 30 Gy in 10 fractions conventional whole brain radiotherapy will be administered	Radiation: Conventional whole brain radiotherapy; 30 Gy in 10 fractions conventional whole brain radiotherapy will be administered

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total recall assessed using Hopkins Verbal Learning Test-Revised (HVTLR) at 4 months	A decline in total recall will be assessed as being clinically significant if there is at least a 5 point decrease in total recall score at 4 months, compared to baseline [Jacobson 1991, Brandt 1998]	4 months after completion of WBRT or HS-WBRT

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neurocognitive function	NCF, using a 30-60 min test battery (Memory - HVLT-R, Wechsler Memory Scale (logical memory subtest), Rey figure test, Wechsler digit span; Attention - Test of Everyday Attention (map search subtest), Trail Making Test (Parts A and B); Language - Graded Naming Test); this may be revised in the light of forthcoming recommendations on NCF assessment in brain metastases trials by the RANO (Revised Assessment in Neuro-oncology) working party	2, 4, 6, 12 and 24 months after completion of WBRT or HS-WBRT
Quality of life	Quality of life will be assessed using EORTC QLQ C30 and BN20 and EuroQol EQ-5D questionnaires	2, 4, 6, 9, 12, 18 and 24 months after completion of WBRT or HS-WBRT
Length of time functionally independent	The duration of functional independence will be assessed as the time for which the Karnofsky Performance Status ≥ 70	2, 4, 6, 9, 12, 18 and 24 months after completion of WBRT or HS-WBRT
Local control of surgery/SRS treated metastases, local and distant intracranial control (treated and new metastases), and disease control within the hippocampal regions	Incidence of metastases within the perihippocampal region, local control, and intracranial control will be assessed on the basis of MRI imaging	2, 4, 6, 9, 12, 18 and 24 months after completion of WBRT or HS-WBRT
Overall survival	Date of death will be determined from the medical records, or from the GP	followed up until 24 months after completion of WBRT or HS-WBRT
Steroid and antiepileptic medication requirements	Steroid and antiepileptic medication use will be recorded in patient diaries and assessed at clinic visits	2, 4, 6, 9, 12, 18 and 24 months after completion of WBRT or HS-WBRT
Acute and late side effects of radiotherapy	Acute and late side effects of radiotherapy will be assessed using NCI CTCAE scale v4.03	2, 4, 6, 9, 12, 18 and 24 months after completion of WBRT or HS-WBRT

Collaborators and Investigators

• Sponsor: University College, London
• Collaborators: Cancer Research UK; The Brain Tumour Charity
• Investigators: Study Chair: Gillian Whitfield, MA,MB BS,PhD, The Christie NHS Foundation Trust

Study record dates

Study Major Dates

• Study Start (Actual): August 3, 2016
• Primary Completion (Actual): June 1, 2018
• Study Completion (Actual): February 16, 2021

Study Registration Dates

• First Submitted: May 21, 2014
• First Submitted That Met QC Criteria: May 23, 2014
• First Posted (Estimate): May 26, 2014

Study Record Updates

• Last Update Posted (Actual): February 25, 2021
• Last Update Submitted That Met QC Criteria: February 24, 2021
• Last Verified: February 1, 2021

More Information

Terms related to this study

• Keywords: neurocognitive function; whole brain RT; hippocampal sparing
• Additional Relevant MeSH Terms: Pathologic Processes; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neoplasms; Neoplasms by Site; Neoplastic Processes; Central Nervous System Neoplasms; Nervous System Neoplasms; Neoplasm Metastasis; Brain Neoplasms
• Other Study ID Numbers: UCL/12/0512; Cancer Research UK (Other Grant/Funding Number: CRUK/11/010)