A prospective interventional study evaluating seizure activity during a radiotherapy course for high-grade gliomas (SURF-ROGG)

Dirk Rades, Jaspar Witteler, Denise Olbrich, Peter Trillenberg, Steven E Schild, Soeren Tvilsted, Troels W Kjaer, Dirk Rades, Jaspar Witteler, Denise Olbrich, Peter Trillenberg, Steven E Schild, Soeren Tvilsted, Troels W Kjaer

Abstract

Background: Gliomas are often associated with symptoms including seizures. Most patients with high-grade gliomas are treated with radiotherapy or radio-chemotherapy. Since irradiation causes inflammation, it may initially aggravate symptoms. Studies focusing on seizure activity during radiotherapy for gliomas are not available. Such knowledge may improve patient monitoring and anti-epileptic treatment. This study evaluates seizure activity during radiotherapy for high-grade gliomas.

Methods: The primary objective this prospective interventional study is the evaluation of seizure activity during a course of radiotherapy for high-grade gliomas. Progression of seizure activity is defined as increased frequency of seizures by > 50%, increased severity of seizures, or initiation/increase by ≥25% of anti-epileptic medication. Seizure frequency up to 6 weeks following radiotherapy and electroencephalography activity typical for epilepsy will also be evaluated. Patients keep a seizure diary during and up to 6 weeks following radiotherapy. Every day, they will document number (and type) of seizures and anti-epileptic medication. Once a week, the findings of the diary are checked and discussed with a neurologist to initiate or adjust anti-epileptic medication, if necessary. Patients complete a questionnaire regarding their satisfaction with the seizure diary. If the dissatisfaction rate is > 40%, the seizure diary will be considered not suitable for the investigated indication. Thirty-five patients (32 patients plus drop-outs) should be enrolled. With this sample size, a one-sample binomial test with a one-sided significance level of 2.5% has a power of 80% to yield statistical significance, if the rate of patients with progression of seizure activity is 30% (rate under the alternative hypothesis), assuming a 'natural' background progression-rate of 10% without radiotherapy (null hypothesis).

Discussion: If an increase in seizure activity during a course of radiotherapy for high-grade glioma occurs, the findings of this study may pave the way for a larger prospective trial and will likely lead to closer patient monitoring and better anti-epileptic treatment.

Trial registration: clinicaltrials.gov ( NCT04552756 ); registered on 16th of September, 2020.

Keywords: High-grade glioma; Radio-chemotherapy; Radiotherapy; Seizure diary; Seizures.

Conflict of interest statement

Dirk Rades is associate editor of BMC Cancer. Otherwise, no competing interests exist regarding this trial.

Figures

Fig. 1
Fig. 1
Timeline of enrolment, interventions and assessments of the SURF-ROGG trial

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