Stereotaktická radiochirurgie s jednou frakcí ve srovnání s frakční stereotaktickou radiochirurgií pro léčbu intaktního metastatického onemocnění mozku, FRAKČNÍ studie
Fáze IIR studie jednofrakční stereotaktické radiochirurgie (SRS) ve srovnání s frakcionovanou SRS (FSRS) pro intaktní metastatické onemocnění mozku (FRACTIONATE)
This phase II trial compares the effect of single fraction stereotactic radiosurgery to fractionated stereotactic radiosurgery for the treatment of patients with cancer that has spread to the brain (metastatic brain disease). Stereotactic radiosurgery (SRS) is a form of radiation therapy that focuses high-power energy on a small area of the body. This trial is being done to determine if single (one) fraction stereotactic radiosurgery is better than fractionated stereotactic radiosurgery or vice versa in controlling tumor and side effects in patients with tumors that have spread to the brain.
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
Detailní popis
PRIMARY OBJECTIVE:
I. To ascertain if the composite endpoint of cumulative treatment failure, defined by time to either local failure or symptomatic radiation brain necrosis of the largest brain metastasis (target lesion), is increased with fractionated stereotactic radiosurgery (FSRS) compared to single fraction stereotactic radiosurgery (SSRS).
SECONDARY OBJECTIVES:
I. To ascertain whether there is improved overall survival in patients who undergo FSRS compared to patients who receive SSRS.
II. To tabulate and descriptively compare the post-treatment adverse events associated with the interventions, including the potential impact of immunotherapy and targeted therapy.
III. To compare rates of radiation necrosis in patients who receive FSRS to patients who receive SSRS.
IV. To evaluate if there is any difference in central nervous system (CNS) failure patterns (e.g. local, distant brain failure) in patients who receive FSRS compared to patients who receive SSRS.
V. To ascertain whether FSRS prolongs time to neurologic death as compared to SRS.
VI. To determine whether there is improved patient reported outcomes (Functional Assessment of Cancer Therapy [FACT]-Brain Symptom Index [FBrSI]-24) including quality of life for patients who receive FSRS compared to patients who receive SSRS.
VII. To evaluate if there is any difference in CNS failure patterns (e.g. local, distant brain failure) and symptomatic radiation necrosis rates in patients who are treated with gamma knife compared to patients who are treated with a linear accelerator platform.
VIII. To determine whether differences in time to local failure, time to necrosis, or their composite endpoint cumulative treatment failure differs between treatment arms (or other patient or treatment factors) when analyzed on a "per lesion" basis rather than the per patient basis utilized for the primary endpoint.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM A: Patients undergo single fraction SRS. Patients also undergo magnetic resonance imaging (MRI) at screening and during follow up.
ARM B: Patients undergo fractionated SRS, for 3-5 treatments, given over no more than 8 days. Patients also undergo MRI at screening and during follow up.
After completion of study treatment, patients are followed up at 3 months, every 3 months for 2 years, and then every 6 months for 3 years.
Typ studie
Typ studie
Zápis (Odhadovaný)
Zápis
Fáze
Fáze
- Fáze 2
Kontakty a umístění
Studijní kontakt
Studijní kontakt
- Jméno: Clinical Trials Referral Office
- Telefonní číslo: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
Studijní místa
-
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Arizona
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Scottsdale, Arizona, Spojené státy, 85259
- Nábor
- Mayo Clinic in Arizona
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Kontakt:
- Clinical Trials Referral Office
- Telefonní číslo: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
-
Vrchní vyšetřovatel:
- Sujay A. Vora, MD
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Florida
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Jacksonville, Florida, Spojené státy, 32224
- Nábor
- Mayo Clinic in Florida
-
Kontakt:
- Clinical Trials Referral Office
- Telefonní číslo: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
-
Vrchní vyšetřovatel:
- Jennifer L. Peterson, MD
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Minnesota
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Albert Lea, Minnesota, Spojené státy, 56007
- Zatím nenabíráme
- Mayo Clinic Health System in Albert Lea
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Kontakt:
- Clinical Trials Referral Office
- Telefonní číslo: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
-
Vrchní vyšetřovatel:
- John Yeakel, MD
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Kontakt:
- Lori Rhodes
- Telefonní číslo: 507-284-0063
- E-mail: Rhodes.Lori@mayo.edu
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Mankato, Minnesota, Spojené státy, 56001
- Nábor
- Mayo Clinic Health Systems-Mankato
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Kontakt:
- Clinical Trials Referral Office
- Telefonní číslo: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
-
Kontakt:
- Lori Rhodes
- Telefonní číslo: 507-284-0063
- E-mail: Rhodes.Lori@mayo.edu
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Vrchní vyšetřovatel:
- Jason T. Hayes, MD
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Rochester, Minnesota, Spojené státy, 55905
- Nábor
- Mayo Clinic in Rochester
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Vrchní vyšetřovatel:
- Paul D. Brown, M.D.
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Kontakt:
- Clinical Trials Referral Office
- Telefonní číslo: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
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Wisconsin
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Eau Claire, Wisconsin, Spojené státy, 54701
- Nábor
- Mayo Clinic Health System-Eau Claire Clinic
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Kontakt:
- Clinical Trials Referral Office
- Telefonní číslo: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
-
Vrchní vyšetřovatel:
- Now Bahar Alam, MD
-
Kontakt:
- Lori Rhodes
- Telefonní číslo: 507-284-0063
- E-mail: Rhodes.Lori@mayo.edu
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La Crosse, Wisconsin, Spojené státy, 54601
- Nábor
- Mayo Clinic Health System-Franciscan Healthcare
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Kontakt:
- Clinical Trials Referral Office
- Telefonní číslo: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
-
Vrchní vyšetřovatel:
- Abigail L. Stockham, MD
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Kontakt:
- Lori Rhodes
- Telefonní číslo: 507-284-0063
- E-mail: Rhodes.Lori@mayo.edu
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Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
Inclusion Criteria:
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Age >= 18 years old
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Presence of presumed brain metastases from an extra-cerebral tumor site (e.g. lung, breast, prostate, etc.)
- Note: Dural based metastases (e.g. commonly seen in breast cancer) are eligible
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Size of brain metastases
- At least one intact metastasis (not previously treated with radiosurgery) must measure >= 2.0 cm and =< 4.0 cm in maximal extent on the contrasted pre-treatment magnetic resonance imaging (MRI) brain scan obtained =< 28 days prior to registration
- If the largest lesion measures >= 2.0 to =< 4.0 cm in maximal extent the patient will be randomized
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Able to undergo contrast enhanced MRI brain
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Negative urine or serum pregnancy test completed =< 7 days prior to registration, for women of childbearing potential only
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Patient is willing and able to provide written informed consent or have a legally Authorized Representative (LAR) who is responsible for the care and well-being of the potential study participant provide consent.
-
Karnofsky performance status (KPS) >= 50
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Eastern Cooperative Oncology Group (ECOG) performance score of (PS) >= 2
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Past radiosurgery or resection is allowed as long as no definitive evidence of progression in these locations
- Note: Repeat radiosurgery to the same location/lesion is not allowed on this protocol
Exclusion Criteria:
-
Any patient who has received previous whole brain radiation
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Any brain metastasis that is located in the brainstem measuring >= 2.0 cm in maximal extent
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Any patient with definitive evidence of leptomeningeal metastasis (LMD)
- NOTE: For the purposes of exclusion, LMD is a clinical diagnosis, defined as positive cerebrospinal fluid (CSF) cytology and/or unequivocal radiologic or clinical evidence of leptomeningeal involvement. Patients with leptomeningeal symptoms in the setting of leptomeningeal enhancement by imaging (MRI) would be considered to have LMD even in the absence of positive CSF cytology, unless a parenchymal lesion can adequately explain the neurologic symptoms and/or signs. In contrast, an asymptomatic or minimally symptomatic patient with mild or nonspecific leptomeningeal enhancement (MRI) would not be considered to have LMD. In that patient, CSF sampling is not required to formally exclude LMD, but can be performed at the investigator's discretion based on level of clinical suspicion
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Any patient with an intact brain metastasis measuring > 4.0 cm
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Žádné (otevřený štítek)
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
|---|---|
|
Jiný: Arm A (single fraction SRS)
Patients undergo single fraction SRS. Patients also undergo MRI at screening and during follow up. |
Undergo MRI
Ostatní jména:
Ancillary studies Undergo single fraction SRS
Ostatní jména:
Undergo fractionated SRS
Ostatní jména:
|
|
Jiný: Arm B (fractionated SRS)
Patients undergo fractionated SRS, for 3-5 treatments, given over no more than 8 days.. Patients also undergo MRI at screening and during follow up. |
Undergo MRI
Ostatní jména:
Ancillary studies Undergo single fraction SRS
Ostatní jména:
Undergo fractionated SRS
Ostatní jména:
|
Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Time to local failure or symptomatic radiation brain necrosis of large brain metastasis
Časové okno: Up to 5 years
|
Will determine if the composite endpoint of time to local failure or symptomatic radiation brain necrosis of a large brain metastasis [cumulative treatment failure (CTF)] is increased with fractionated stereotactic radiosurgery (FSRS) compared to single fraction stereotactic radiosurgery (SSRS). |
Up to 5 years
|
Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Overall survival (OS)
Časové okno: From study entry to death from any cause, assessed up to 5 years
|
OS will be estimated using the Kaplan-Meier method, where the log-rank test will be used to compare the 2 treatment arms. Medians and 95% confidence intervals will be reported. |
From study entry to death from any cause, assessed up to 5 years
|
|
Incidence of adverse events
Časové okno: Up to 2 years post radiation therapy
|
The maximum grade for each type of adverse event will be summarized using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The frequency and percentage of grade 3+ adverse events will be compared between the 2 treatment arms. Comparisons between arms will be made by using either the Chi-square or Fisher's Exact test. |
Up to 2 years post radiation therapy
|
|
Rates of radiation necrosis
Časové okno: Up to 5 years
|
Will compare rates of radiation necrosis in patients who receive FSRS to patients who receive SSRS. Comparisons between arms will be made by using either the Chi-square or Fisher's Exact test. |
Up to 5 years
|
|
Central nervous system (CNS) failure patterns (Fractionation)
Časové okno: Up to 5 years
|
Will evaluate if there is any difference in CNS failure patterns (e.g. local, distant brain failure) in patients who receive FSRS compared to patients who receive SSRS. Comparisons between arms will be made by using either the Chi-square or Fisher's Exact test. |
Up to 5 years
|
|
Time to neurologic death
Časové okno: Up to 5 years
|
Will ascertain whether FSRS prolongs time to neurologic death as compared to SSRS. This will be estimated using the Kaplan-Meier method, where the log-rank test will be used to compare the 2 treatment arms. Medians and 95% confidence intervals will be reported. |
Up to 5 years
|
|
Quality of life (QOL)
Časové okno: Up to 5 years
|
Will determine whether there are improved patient reported outcomes (Functional Assessment of Cancer Therapy [FACT]-Brain Symptom Index [FBrSI]-24) including quality of life for patients who receive FSRS compared to patients who receive SSRS. Changes over time in QOL from baseline will be compared between arms using the 2-sample t-test (or Wilcoxon Rank-Sum test for non-normal data). Box-plots will be used to show differences between arms graphically. |
Up to 5 years
|
|
CNS failure patterns (Gamma Knife)
Časové okno: Up to 5 years
|
Will evaluate if there is any difference in CNS failure patterns (e.g. local, distant brain failure) and symptomatic radiation necrosis rates in patients who are treated with Gamma Knife compared to patients who are treated with a linear accelerator platform. Comparisons between arms will be made by using either the Chi-square or Fisher's Exact test. |
Up to 5 years
|
|
Per lesion analysis between treatment arms: time to local failure
Časové okno: Up to 5 years
|
Will determine whether differences in time to local failure differs between treatment arms (or other patient or treatment factors) when analyzed on a "per lesion" basis rather than the per patient basis utilized for the primary endpoint. Time-to-event models (Cox and Kaplan- Meier) with sandwich estimators for covariance will be utilized to in treatment comparisons, with model comparisons completed through log-likelihood and Akaike Information Criterion. |
Up to 5 years
|
|
Per lesion analysis between treatment arms: time to necrosis
Časové okno: Up to 5 years
|
Will determine whether differences in time to necrosis differs between treatment arms (or other patient or treatment factors) when analyzed on a "per lesion" basis rather than the per patient basis utilized for the primary endpoint. Time-to-event models (Cox and Kaplan- Meier) with sandwich estimators for covariance will be utilized to in treatment comparisons, with model comparisons completed through log-likelihood and Akaike Information Criterion. |
Up to 5 years
|
|
Per lesion analysis between treatment arms: endpoint CTF
Časové okno: Up to 5 years
|
Will determine whether differences in the composite endpoint CTF differs between treatment arms (or other patient or treatment factors) when analyzed on a "per lesion" basis rather than the per patient basis utilized for the primary endpoint. Time-to-event models (Cox and Kaplan- Meier) with sandwich estimators for covariance will be utilized to in treatment comparisons, with model comparisons completed through log-likelihood and Akaike Information Criterion. |
Up to 5 years
|
Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Vyšetřovatelé
Vyšetřovatelé
- Vrchní vyšetřovatel: Paul D. Brown, MD, Mayo Clinic in Rochester
Publikace a užitečné odkazy
Užitečné odkazy
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Začátek studia
Primární dokončení (Odhadovaný)
Primární dokončení
Dokončení studie (Odhadovaný)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Další relevantní podmínky MeSH
- Onemocnění mozku
- Onemocnění centrálního nervového systému
- Nemoci nervového systému
- Patologické procesy
- Novotvary podle místa
- Novotvary
- Neoplastické procesy
- Novotvary nervového systému
- Novotvary centrálního nervového systému
- Patologické stavy, příznaky a symptomy
- Metastáza novotvaru
- Novotvary mozku
- Vyšetřovací techniky
- Terapeutika
- Chirurgické postupy, operativní
- Fyzické jevy
- Techniky chemie, analytické
- Analýza spektra
- Elektromagnetické jevy
- Magnetické jevy
- Radioterapie
- Stereotaxické techniky
- Neurochirurgické postupy
- Elektromagnetické záření
- Záření
- Záření, ionizující
- Magnetická rezonanční spektroskopie
- Radiochirurgie
- Rentgenové paprsky
Další identifikační čísla studie
Další identifikační čísla studie
- GMROR2163
- NCI-2021-14230 (Identifikátor registru: CTRP (Clinical Trial Reporting Program))
- 21-003768 (Jiný identifikátor: Mayo Clinic Institutional Review Board)
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
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