- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03529708
Stereotactic Body Radiotherapy Boost After Palliative Radiotherapy for Spinal Cord Compression (CRUSSH)
Stereotactic Body Radiotherapy (SBRT) Boost Following Urgent 3D Conformal Radiotherapy in the Treatment of Metastatic Epidural Spinal Cord Compression (SCC): A Phase I Feasibility Trial
Spinal cord compression (SCC) is a devastating complication of advanced malignancy, and can cause significant deterioration in function and quality of life (QoL). The goal of treatment is to improve functional status and symptoms, but the optimal treatment regimen for these patients has not been thoroughly established. Many patients with SCC present with uncontrolled systemic disease and poor performance status, and are not eligible for standard surgical resection. They are generally treated with 3D conformal palliative RT (3DCRT) alone, however recent trials suggest that less than 70% of patients are ambulatory, that the re-establishment of ambulation in non-ambulatory patients is poor, and the duration of improvement is guarded with radiotherapy alone.
Recently, stereotactic body radiotherapy (SBRT) used alone or after previous radiotherapy to treat spinal metastasis has demonstrated superior results in pain control, tumour response and durability. SBRT requires time for careful planning, and many patients with neurologic symptoms must be treated immediately to prevent progression. Therefore the role of SBRT is still unclear in this patient population, although it seems to be a potential alternative to surgical decompression in patient not suitable for surgery. The investigators propose a feasibility study to investigate the potential benefits of dose escalation with a sequential SBRT boost to urgent 3D CRT in the setting of SCC. This regimen will allow inoperable patients to receive urgent 3DCRT while simultaneously creating the opportunity for superior outcomes with SBRT. The investigators also aim to characterize the effect on motor function and ambulation, pain and QoL. This study could stimulate further multi-center randomized trials in this area, improve motor function and patient-reported QoL, and contribute to improving oncology care in Canada in a meaningful way.
Study Overview
Status
Intervention / Treatment
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Elysia K Donovan, MD,FRCPC
- Phone Number: 9053879495
- Email: donovane@hhsc.ca
Study Contact Backup
- Name: Shelley Chambers, MA
- Phone Number: 9053879495
Study Locations
-
-
Ontario
-
Hamilton, Ontario, Canada, L8V1C5
- Recruiting
- Juravinski Cancer Center
-
Contact:
- Kara L Schnarr
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Diagnosis of metastatic malignancy (radiologic or pathologic)
- Evidence of disease in vertebral body with epidural component such that Bilsky radiologic score is 1c-2 on MRI (abuts spinal cord without cord compression (1c), or spinal cord compression but with visible CSF (2)
- Motor function (MF) of 3 or greater
Exclusion Criteria:
- Surgical candidate
- Instability of vertebral bodies with or without bony retropulsion requiring surgical intervention or hardware placement
- Previous radiotherapy course to same region of spine with overlapping fields (prior to phase I course) at discretion of treating radiation oncologist
- No CT or MRI within previous 3 months
- Life expectancy estimated <3 months
- Performance status KPS<40
- On active chemotherapy or targeted therapy or immunotherapy (must be stopped for at least one week prior to and following)
- Pregnant or lactating
- Contraindications to radiotherapy (eg. active autoimmune disease requiring medication)
- Inability to lie flat comfortably for at least 20 minutes
- Age < 18
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: SBRT boost
Standard radiotherapy (3D conformal, urgent palliative radiotherapy) plus stereotactic body radiotherapy (SBRT) boost
|
Patients will receive urgent standard 3D conformal radiotherapy (3D CRT) of plus stereotactic boost to tumor causing spinal cord compression (SCC).
Initial dose for 3D CRT will be either 8Gy in 1 fraction or 20Gy in 5 fractions, with SBRT boost dose15Gy in 2 fractions of 12Gy in 2 fractions (depending on 8Gy/1 or 20Gy/5 initial RT dose respectively), delivered within three weeks of first treatment.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility of accrual
Time Frame: up to 12 months
|
Success determined by accrual of 30 patients with SBRT boost is planned and delivered to 80% of these
|
up to 12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Motor Function Description:
Time Frame: 4 weeks (primary), 12 weeks, 6 months
|
Motor strength evaluated by 8 point scale (0= Complete paraplegia, 1= Palpable or visible muscle contractions, 2= Active movement of the leg without gravity, 3= Active movement of the leg against gravity, 4= Active movement againt mild resistance, 5= Active movement against intermediate resistance, 6= Active movement against strong resistance, 7= Normal strength)
|
4 weeks (primary), 12 weeks, 6 months
|
Overall Quality of Life (QoL)
Time Frame: 4 weeks, 12 weeks, 6 months
|
Change in total QoL score over time per European Organization for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-c30)
|
4 weeks, 12 weeks, 6 months
|
Pain Response
Time Frame: 4 weeks, 12 weeks, 6 months
|
Change in level of pain over time on 10 point scale with 0 meaning no pain and 10 meaning severe pain (patient-reported)
|
4 weeks, 12 weeks, 6 months
|
Local Control
Time Frame: 12 weeks, 6 months
|
Assessment of tumor volume (maximum size in 3 dimension) by Magnetic Resonance Imaging (MRI)
|
12 weeks, 6 months
|
Toxicity
Time Frame: 4 weeks, 12 weeks, 6 months
|
Treatment-related toxicity graded by Common Terminology for Adverse Events (CTCAE 4.03)
|
4 weeks, 12 weeks, 6 months
|
Overall Survival
Time Frame: 4 weeks, 12 weeks, 6 months
|
Survival time from first radiotherapy treatment (3D CRT) in days
|
4 weeks, 12 weeks, 6 months
|
Bone metastasis- specific Quality of Life
Time Frame: 4 weeks, 12 weeks, 6 months
|
Change in total QoL score over time per European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Bone Metastasis-22 (EORTC QLQ BM-22)
|
4 weeks, 12 weeks, 6 months
|
Collaborators and Investigators
Sponsor
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 4760
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Spinal Cord Compression
-
M.D. Anderson Cancer CenterActive, not recruitingMetastatic Epidural Spinal Cord CompressionUnited States
-
University of MiamiViewray Inc.Not yet recruitingSpinal Cord Compression | Metastatic Epidural Spinal Cord CompressionUnited States
-
Washington University School of MedicineCelgeneTerminatedCord CompressionUnited States
-
M.D. Anderson Cancer CenterCompletedMetastatic Epidural Spinal Cord CompressionUnited States
-
The University of Texas Health Science Center,...TerminatedSpinal Cord Injuries | Cervical Spinal Cord Injury | Traumatic Spinal Cord CompressionUnited States
-
Prof. Dirk Rades, MDCompletedMetastatic Epidural Spinal Cord CompressionUnited States, Slovenia, Germany, Lithuania, Saudi Arabia, Spain
-
University Hospital Schleswig-HolsteinRecruitingSpinal Cord Compression Due to Metastasis to SpineGermany
-
University Hospital Schleswig-HolsteinCompletedSpinal Cord Compression Due to Metastasis to SpineGermany
-
AOSpine North America Research NetworkAOSpine North AmericaCompletedMetastatic Epidural Spinal Cord CompressionUnited States, Canada
-
Masaryk UniversityPalacky UniversityRecruitingDegenerative Cervical Spinal Myelopathy | Cervical Spinal Cord CompressionCzechia
Clinical Trials on 3D CRT plus SBRT boost
-
University of ZurichActive, not recruitingSpinal MetastasisSwitzerland
-
Second Affiliated Hospital, School of Medicine,...Recruiting
-
IRCCS Azienda Ospedaliero-Universitaria di BolognaRecruitingBreast Cancer | RadiotherapyItaly
-
Fujian Cancer HospitalCompletedNasopharyngeal Cancer RecurrentChina
-
Radiation Therapy Oncology GroupNational Cancer Institute (NCI); NRG OncologyActive, not recruitingBreast CancerUnited States, Canada, Israel, Hong Kong, Korea, Republic of, Singapore, Switzerland, Japan
-
Eastern Hepatobiliary Surgery HospitalCompletedHepatocellular Carcinoma | Portal Vein Tumor Thrombus | Laser AblationChina
-
Centre hospitalier de l'Université de Montréal...Recruiting
-
IRCCS Azienda Ospedaliero-Universitaria di BolognaCompletedBreast Cancer | Radiation Toxicity
-
Juravinski Cancer CenterSanofiUnknown
-
Radiation Therapy Oncology GroupNational Cancer Institute (NCI)CompletedProstate CancerCanada, United States