- ICH GCP
- Registro degli studi clinici negli Stati Uniti
- Sperimentazione clinica NCT00047320
Neoadjuvant Chemotherapy With or Without Second-Look Surgery Followed by Radiation Therapy With or Without Peripheral Stem Cell Transplantation in Treating Patients With Intracranial Germ Cell Tumors
A Phase II Study To Assess The Ability Of Neoadjuvant Chemotherapy Plus/Minus Second Look Surgery To Eliminate All Measurable Disease Prior To Radiotherapy For NGGCT
RATIONALE: Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Giving a chemotherapy drug before surgery may shrink the tumor so that it is no longer present by conventional imaging and tumor markers from serum and cerebrospinal fluid. Radiation therapy uses high-energy x-rays to damage tumor cells. Peripheral stem cell transplantation may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells. Combining different types of therapy may kill more tumor cells.
PURPOSE: This Phase II trial is studying how well neoadjuvant chemotherapy with or without surgery and with or without high dose chemotherapy and peripheral stem cell transplantation, can increase response rates prior to radiation therapy and increase progression free and overall surviving patients with newly diagnosed intracranial germ cell tumors.
Panoramica dello studio
Stato
Condizioni
Descrizione dettagliata
OBJECTIVES:
- Determine the response rate of patients with non-germinomatous germ cell tumors treated with neoadjuvant chemotherapy.
- Determine the progression-free survival and overall survival of patients treated with neoadjuvant chemotherapy with or without second-look surgery followed by radiotherapy with or without autologous peripheral blood stem cell transplantation (PBSCT).
- Determine whether additional complete responses can be achieved after high-dose thiotepa and etoposide with PBSCT in patients with persistently positive markers, histological evidence of residual malignant elements, or unresectable residual tumors after initial neoadjuvant chemotherapy.
- Determine patterns of recurrence in patients treated with this regimen.
- Correlate tumor marker response with radiographic and clinical measures of response, as well as findings at second-look surgery in patients with radiological evidence of residual disease.
OUTLINE:
Induction chemotherapy:
- Courses 1, 3, and 5: Patients receive carboplatin IV over 1 hour on day 1 and etoposide IV over 1 hour on days 1-3. Beginning on day 4, patients receive filgrastim (G-CSF) IV or subcutaneously (SC) for 10 days or until blood counts recover. Courses are 3 weeks in duration.
- Courses 2, 4, and 6: Patients receive etoposide IV over 1 hour followed by ifosfamide IV over 1 hour on days 1-5. Beginning on day 6, patients receive G-CSF IV or SC for 10 days or until blood counts recover. Courses are 3 weeks in duration.
Patients undergo re-evaluation. Patients with a complete response (CR) go directly to radiotherapy. Approximately 3 weeks after completion of induction chemotherapy, all patients with less than a CR are encouraged to undergo second-look surgery.
After second-look surgery, patients with a CR or a partial response (PR) go directly to radiotherapy. Patients with less than a PR undergo consolidation chemotherapy with peripheral blood stem cell rescue (PBSC) followed by radiotherapy.
- Consolidation chemotherapy: Patients undergo PBSC collection. Patients receive G-CSF SC until PBSC collection is complete. Patients then receive thiotepa IV over 3 hours followed by etoposide IV over 3 hours on days -5 to -3. PBSCs are reinfused on day 0. Beginning on day 1 and continuing until blood counts recover, patients receive G-CSF SC daily.
- Radiotherapy: All patients receive radiotherapy once daily 5 days a week for 5-6 weeks beginning after recovery from induction chemotherapy or second-look surgery or within 9 weeks after PBSC reinfusion.
Patients are followed every 3 months for 1 year, every 4 months for 1 year, every 6 months for 1 year, and then annually thereafter.
PROJECTED ACCRUAL: A total of 80-100 patients will be accrued for this study within 36-42 months.
Tipo di studio
Iscrizione (Effettivo)
Fase
- Fase 2
Contatti e Sedi
Luoghi di studio
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Queensland
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Brisbane, Queensland, Australia, 4029
- Royal Children's Hospital
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Victoria
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Parkville, Victoria, Australia, 3052
- Royal Children's Hospital
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Western Australia
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Perth, Western Australia, Australia, 6001
- Princess Margaret Hospital for Children
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Quebec, Canada, G1V 4G2
- Centre Hospitalier Universitaire de Quebec
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British Columbia
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Vancouver, British Columbia, Canada, V6H 3V4
- Children's & Women's Hospital of British Columbia
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Newfoundland and Labrador
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St. John's, Newfoundland and Labrador, Canada, A1B 3V6
- Janeway Children's Health and Rehabilitation Centre
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Nova Scotia
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Halifax, Nova Scotia, Canada, B3K 6R8
- IWK Health Centre
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Ontario
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Hamilton, Ontario, Canada, L8N 3Z5
- McMaster Children's Hospital at Hamilton Health Sciences
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Toronto, Ontario, Canada, M5G 1X8
- Hospital for Sick Children
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Quebec
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Montreal, Quebec, Canada, H3H 1P3
- Montreal Children's Hospital at McGill University Health Center
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Montreal, Quebec, Canada, H3T 1C5
- Hopital Sainte Justine
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Saskatchewan
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Saskatoon, Saskatchewan, Canada, S7N 4H4
- Saskatoon Cancer Centre at the University of Saskatchewan
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-
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-
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Auckland, Nuova Zelanda, 1
- Starship Children's Health
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Christchurch, Nuova Zelanda
- Christchurch Hospital
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Alabama
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Birmingham, Alabama, Stati Uniti, 35294
- Lurleen Wallace Comprehensive Cancer at University of Alabama - Birmingham
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Arizona
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Phoenix, Arizona, Stati Uniti, 85016-7710
- Phoenix Children's Hospital
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Arkansas
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Little Rock, Arkansas, Stati Uniti, 72205
- Arkansas Cancer Research Center at University of Arkansas for Medical Sciences
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California
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Downey, California, Stati Uniti, 90242-2814
- Southern California Permanente Medical Group
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Loma Linda, California, Stati Uniti, 92354
- Loma Linda University Cancer Institute at Loma Linda University Medical Center
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Long Beach, California, Stati Uniti, 90801
- Jonathan Jaques Children's Cancer Center at Miller Children's Hospital
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Los Angeles, California, Stati Uniti, 90027
- Childrens Hospital Los Angeles
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Madera, California, Stati Uniti, 93638-8762
- Children's Hospital Central California
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Oakland, California, Stati Uniti, 94609
- Children's Hospital and Research Center Oakland
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Orange, California, Stati Uniti, 92868
- Children's Hospital of Orange County
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Sacramento, California, Stati Uniti, 95816
- Sutter Cancer center
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San Diego, California, Stati Uniti, 92123-4282
- Rady Children's Hospital - San Diego
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San Francisco, California, Stati Uniti, 94115
- UCSF Helen Diller Family Comprehensive Cancer Center
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Stanford, California, Stati Uniti, 94305-5824
- Stanford Cancer Center
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Connecticut
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Farmington, Connecticut, Stati Uniti, 06360-2875
- Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center
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Delaware
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Wilmington, Delaware, Stati Uniti, 19803
- Alfred I. DuPont Hospital for Children
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District of Columbia
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Washington, District of Columbia, Stati Uniti, 20010-2970
- Children's National Medical Center
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Florida
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Fort Myers, Florida, Stati Uniti, 33901
- Lee Cancer Care of Lee Memorial Health System
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Gainesville, Florida, Stati Uniti, 32610-0232
- University of Florida Shands Cancer Center
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Jacksonville, Florida, Stati Uniti, 32207
- Nemours Children's Clinic
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Miami, Florida, Stati Uniti, 33136
- University of Miami Sylvester Comprehensive Cancer Center - Miami
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Miami, Florida, Stati Uniti, 33155
- Miami Children's Hospital
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Orlando, Florida, Stati Uniti, 32803-1273
- Florida Hospital Cancer Institute at Florida Hospital Orlando
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Pensacola, Florida, Stati Uniti, 32504
- Sacred Heart Cancer Center at Sacred Heart Hospital
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Saint Petersburg, Florida, Stati Uniti, 33701
- All Children's Hospital
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Tampa, Florida, Stati Uniti, 33607
- St. Joseph's Cancer Institute at St. Joseph's Hospital
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West Palm Beach, Florida, Stati Uniti, 33407
- Kaplan Cancer Center at St. Mary's Medical Center
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Georgia
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Atlanta, Georgia, Stati Uniti, 30322
- Winship Cancer Institute of Emory University
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Augusta, Georgia, Stati Uniti, 30912-3730
- MBCCOP - Medical College of Georgia Cancer Center
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Illinois
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Chicago, Illinois, Stati Uniti, 60611
- Ann & Robert H. Lurie Children's Hospital of Chicago
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Chicago, Illinois, Stati Uniti, 60637-1470
- University of Chicago Cancer Research Center
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Park Ridge, Illinois, Stati Uniti, 60068-1174
- Advocate Lutheran General Cancer Care Center
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Springfield, Illinois, Stati Uniti, 62794-9677
- Simmons Cooper Cancer Institute
-
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Indiana
-
Indianapolis, Indiana, Stati Uniti, 46202-5289
- Indiana University Melvin and Bren Simon Cancer Center
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Indianapolis, Indiana, Stati Uniti, 46260
- St. Vincent Indianapolis Hospital
-
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Kansas
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Kansas City, Kansas, Stati Uniti, 66160-7357
- Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center
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Maryland
-
Baltimore, Maryland, Stati Uniti, 21231-2410
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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Massachusetts
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Boston, Massachusetts, Stati Uniti, 02115
- Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
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Boston, Massachusetts, Stati Uniti, 02111
- Floating Hospital for Children at Tufts - New England Medical Center
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Michigan
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Detroit, Michigan, Stati Uniti, 48201-1379
- Barbara Ann Karmanos Cancer Institute
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Grand Rapids, Michigan, Stati Uniti, 49503-2560
- Butterworth Hospital at Spectrum Health
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Grosse Pointe Woods, Michigan, Stati Uniti, 48236
- Van Elslander Cancer Center at St. John Hospital and Medical Center
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Lansing, Michigan, Stati Uniti, 48910
- Breslin Cancer Center at Ingham Regional Medical Center
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Minnesota
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Minneapolis, Minnesota, Stati Uniti, 55404
- Children's Hospitals and Clinics of Minnesota - Minneapolis
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Minneapolis, Minnesota, Stati Uniti, 55455
- Masonic Cancer Center at University of Minnesota
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Rochester, Minnesota, Stati Uniti, 55905
- Mayo Clinic Cancer Center
-
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Mississippi
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Jackson, Mississippi, Stati Uniti, 39216-4505
- University of Mississippi Cancer Clinic
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Missouri
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Kansas City, Missouri, Stati Uniti, 64108
- Children's Mercy Hospital
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Saint Louis, Missouri, Stati Uniti, 63110
- Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
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New Jersey
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Hackensack, New Jersey, Stati Uniti, 07601
- Hackensack University Medical Center Cancer Center
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New Brunswick, New Jersey, Stati Uniti, 08903
- Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
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Newark, New Jersey, Stati Uniti, 07112
- Newark Beth Israel Medical Center
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Paterson, New Jersey, Stati Uniti, 07503
- St. Joseph's Hospital and Medical Center
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New Mexico
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Albuquerque, New Mexico, Stati Uniti, 87131-5636
- University of New Mexico Cancer Center
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New York
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Bronx, New York, Stati Uniti, 10461
- Albert Einstein Cancer Center at Albert Einstein College of Medicine
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New York, New York, Stati Uniti, 10016
- NYU Cancer Institute at New York University Medical Center
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New York, New York, Stati Uniti, 10032
- Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center
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Syracuse, New York, Stati Uniti, 13210
- SUNY Upstate Medical University Hospital
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Valhalla, New York, Stati Uniti, 10595
- New York Medical College
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North Carolina
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Charlotte, North Carolina, Stati Uniti, 28232-2861
- Blumenthal Cancer Center at Carolinas Medical Center
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Durham, North Carolina, Stati Uniti, 27710
- Duke Comprehensive Cancer Center
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Ohio
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Akron, Ohio, Stati Uniti, 44308-1062
- Akron Children's Hospital
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Cincinnati, Ohio, Stati Uniti, 45229-3039
- Cincinnati Children's Hospital Medical Center
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Cleveland, Ohio, Stati Uniti, 44195
- Cleveland Clinic Taussig Cancer Center
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Columbus, Ohio, Stati Uniti, 43205-2696
- Nationwide Children's Hospital
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Dayton, Ohio, Stati Uniti, 45404-1815
- Children's Medical Center - Dayton
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Oklahoma
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Oklahoma City, Oklahoma, Stati Uniti, 73104
- Oklahoma University Cancer Institute
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Oregon
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Portland, Oregon, Stati Uniti, 97239-3098
- Oregon Health and Science University Cancer Institute
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Pennsylvania
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Hershey, Pennsylvania, Stati Uniti, 17033-0850
- Penn State Cancer Institute at Milton S. Hershey Medical Center
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Philadelphia, Pennsylvania, Stati Uniti, 19134-1095
- St. Christopher's Hospital for Children
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Philadelphia, Pennsylvania, Stati Uniti, 19104-9786
- Children's Hospital of Philadelphia
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Pittsburgh, Pennsylvania, Stati Uniti, 15213
- Children's Hospital of Pittsburgh
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Rhode Island
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Providence, Rhode Island, Stati Uniti, 02903
- Rhode Island Hospital Comprehensive Cancer Center
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South Carolina
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Charleston, South Carolina, Stati Uniti, 29425
- Hollings Cancer Center at Medical University of South Carolina
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South Dakota
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Sioux Falls, South Dakota, Stati Uniti, 57117-5039
- Sanford Cancer Center at Sanford USD Medical Center
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Tennessee
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Memphis, Tennessee, Stati Uniti, 38105
- St. Jude Children's Research Hospital
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Nashville, Tennessee, Stati Uniti, 37232-6838
- Vanderbilt-Ingram Cancer Center
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Texas
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Austin, Texas, Stati Uniti, 78723
- Dell Children's Medical Center of Central Texas
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Corpus Christi, Texas, Stati Uniti, 78411
- Driscoll Children's Hospital
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Dallas, Texas, Stati Uniti, 75390
- Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
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Fort Worth, Texas, Stati Uniti, 76104
- Cook Children's Medical Center - Fort Worth
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Lubbock, Texas, Stati Uniti, 79410
- Covenant Children's Hospital
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San Antonio, Texas, Stati Uniti, 78229-3993
- Methodist Children's Hospital of South Texas
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San Antonio, Texas, Stati Uniti, 78207
- University of Texas Health Science Center at San Antonio
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Utah
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Salt Lake City, Utah, Stati Uniti, 84113-1100
- Primary Children's Medical Center
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Virginia
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Norfolk, Virginia, Stati Uniti, 23507-1971
- Children's Hospital of The King's Daughters
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West Virginia
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Charleston, West Virginia, Stati Uniti, 25302
- West Virginia University Health Sciences Center - Charleston
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Wisconsin
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Green Bay, Wisconsin, Stati Uniti, 54307-3508
- St. Vincent Hospital Regional Cancer Center
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Marshfield, Wisconsin, Stati Uniti, 54449
- Marshfield Clinic - Marshfield Center
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Milwaukee, Wisconsin, Stati Uniti, 53226
- Midwest Children's Cancer Center
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Bern, Svizzera, 3010
- Swiss Pediatric Oncology Group Bern
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Geneva, Svizzera, 1205
- Swiss Pediatric Oncology Group Geneva
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
DISEASE CHARACTERISTICS:
One of the following diagnoses:
Histologically confirmed intracranial non-germinomatous germ cell tumor (NGGCT) of 1 of the following types:
- Endodermal sinus tumor (yolk sac tumor)
- Embryonal carcinoma
- Choriocarcinoma
- Immature teratoma and teratoma with malignant transformation
- Mixed germ cell tumor
- Histologically confirmed germinoma with elevation of serum/CSF beta human chorionic gonadotropin (HCG) levels greater than 50 mIU/mL or any serum/CSF alpha-fetoprotein (AFP) levels greater than 10 ng/ml or above institutional norm
- Histologically unconfirmed pineal and/or suprasellar tumors with serum/CSF beta HCG levels greater than 50 mIU/mL or AFP levels greater than 10 ng/ml or above institutional norm
- Patients with normal AFP and beta HCG < 50 mIU/mL without histologic diagnosis of a NGGCT or patients with pure germinoma without elevation of tumor marker are ineligible
- Initial diagnosis within the past 31 days
PATIENT CHARACTERISTICS:
Age
- 3 to 24 at diagnosis
Performance status
- No minimum performance level
Life expectancy
- At least 8 weeks
Hematopoietic
- Absolute neutrophil count at least 1,000/mm^3
- Platelet count at least 100,000/mm^3 (transfusion independent)
- Hemoglobin at least 10.0 g/dL (transfusion allowed)
Hepatic
- Bilirubin no greater than 1.5 times upper limit of normal (ULN)
- ALT no greater than 2.5 times ULN
Renal
- Creatinine no greater than 1.5 times ULN OR
- Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min
Pulmonary
- No assisted ventilation
Other
- Seizure disorders allowed
- No patients in status or coma
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patient must use effective contraception
PRIOR CONCURRENT THERAPY:
Biologic therapy
- Not specified
Chemotherapy
- Not specified
Endocrine therapy
- Prior corticosteroids allowed
- Concurrent corticosteroids allowed
- Concurrent endocrine replacement therapy allowed (e.g., L-thyroxine, testosterone, estrogen, desmopressin acetate)
- No concurrent growth hormone therapy
Radiotherapy
- Not specified
Surgery
- More than 1 prior surgery allowed
Other
- No other prior therapy for malignancy
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: N / A
- Modello interventistico: Assegnazione di gruppo singolo
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
|---|---|
|
Sperimentale: Radiation Therapy (CR from Induction)
Patients will receive 6 cycles of Induction chemotherapy consisting of carboplatin and etoposide (Cycles 1, 3, and 5) alternating with ifosfamide and etoposide (Cycles 2, 4, and 6).
The entire length of Induction is 18 weeks unless delay occurs due to myelosuppression or unanticipated toxicity.
Each cycle of Induction will begin when ANC > 750/L and platelets > 75,000/L and when off filgrastim (G-CSF) for at least 48 hours.
Following the Induction phase (weeks 0-18) those patient in CR will undergo radiation therapy.
|
Dato IV
Altri nomi:
Dato IV
Altri nomi:
Dato IV
Altri nomi:
Dato IV
Altri nomi:
craniospinal irradiation
Altri nomi:
|
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Response to Induction Chemotherapy
Lasso di tempo: 18 weeks
|
A patient who achieves a complete or partial response, defined a reduction of at least 65% in tumor size after induction chemotherapy will be considered to have experienced response.
|
18 weeks
|
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
The Probability of Event-free Survival (EFS)
Lasso di tempo: At 3 years from study entry
|
Event-free Survival was defined as time from study entry to death from any cause, disease progression or recurrence, or second malignant neoplasm.
Event-free survival was estimated by KM estimate.
|
At 3 years from study entry
|
|
Progression-free Survival (PFS)
Lasso di tempo: At 3 years from study entry
|
Progression-free Survival was defined as time from study entry to disease progression or recurrence.
Deaths that are clearly unrelated to disease progression, and second neoplasms are censored in this analysis.
Progression -free survival was estimated by KM estimate.
|
At 3 years from study entry
|
|
Overall Survival (OS)
Lasso di tempo: At 3 years from study entry
|
Overall Survival was defined as time from study entry to death from any cause.
Overall survival was estimated by KM estimate.
|
At 3 years from study entry
|
|
Number of Patients Experiencing Toxic Death
Lasso di tempo: During chemotherapy (up to 18 weeks)
|
Toxic death, defined as death predominantly attributable to treatment-related causes.
|
During chemotherapy (up to 18 weeks)
|
|
Occurrence of Non-hematological Grade 4 Toxicity Occurrence of Nonhematological Grade 4 Toxicity
Lasso di tempo: During chemotherapy(up to 18 weeks)
|
The number of patients who experienced non-hematological grade 4 toxicities anytime during chemotherapy.
|
During chemotherapy(up to 18 weeks)
|
Collaboratori e investigatori
Sponsor
Collaboratori
Investigatori
- Cattedra di studio: Stewart Goldman, MD, Ann & Robert H Lurie Children's Hospital of Chicago
Pubblicazioni e link utili
Studiare le date dei record
Studia le date principali
Inizio studio
Completamento primario (Effettivo)
Completamento dello studio (Effettivo)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Stima)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
- tumore delle cellule germinali del sistema nervoso centrale infantile
- teratoma infantile
- tumore maligno a cellule germinali ricorrente nell'infanzia
- coriocarcinoma del sistema nervoso centrale infantile
- tumore embrionale del sistema nervoso centrale infantile
- germinoma infantile del sistema nervoso centrale
- tumore a cellule germinali miste del sistema nervoso centrale infantile
- teratoma infantile del sistema nervoso centrale
- tumore del sacco vitellino del sistema nervoso centrale infantile
- tumore embrionale del sistema nervoso centrale ricorrente nell'infanzia
Termini MeSH pertinenti aggiuntivi
- Malattie del sistema nervoso
- Neoplasie per tipo istologico
- Neoplasie per sede
- Neoplasie
- Neoplasie, cellule germinali ed embrionali
- Neoplasie del sistema nervoso
- Neoplasie del sistema nervoso centrale
- Effetti fisiologici delle droghe
- Meccanismi molecolari dell'azione farmacologica
- Inibitori enzimatici
- Agenti antineoplastici
- Agenti immunosoppressivi
- Fattori immunologici
- Agenti Antineoplastici, Alchilanti
- Agenti Alchilanti
- Agonisti mieloablativi
- Agenti antineoplastici, fitogenici
- Inibitori della topoisomerasi II
- Inibitori della topoisomerasi
- Carboplatino
- Etoposide
- Ifosfamide
- Senape isofosfamide
- Thiotepa
Altri numeri di identificazione dello studio
- ACNS0122
- CDR0000257664 (Altro identificatore: Clinical Trials.gov)
- COG-ACNS0122 (Altro identificatore: Children's Oncology Group)
Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .
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