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無傷の転移性脳疾患の治療のための分割定位放射線手術と比較した単一分割定位放射線手術、FRACTIONATE試験

2026年9月29日 更新者：Mayo Clinic

無傷の転移性脳疾患（FRACTIONATE）に対する分割SRS（FSRS）と比較した単一分割定位放射線手術（SRS）のフェーズIIR試験

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.

調査の概要

状態

募集

条件

介入・治療

詳細な説明

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.

研究の種類

介入

入学 (推定)

90

段階

  • フェーズ2

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究連絡先

研究場所

  • アメリカ
    • Arizona
      • Scottsdale、Arizona、アメリカ、85259
        • 募集
        • Mayo Clinic in Arizona
        • コンタクト：
        • 主任研究者：
          • Sujay A. Vora, MD
    • Florida
      • Jacksonville、Florida、アメリカ、32224
        • 募集
        • Mayo Clinic in Florida
        • コンタクト：
        • 主任研究者：
          • Jennifer L. Peterson, MD
    • Minnesota
      • Albert Lea、Minnesota、アメリカ、56007
        • まだ募集していません
        • Mayo Clinic Health System in Albert Lea
        • コンタクト：
        • 主任研究者：
          • John Yeakel, MD
        • コンタクト：
      • Mankato、Minnesota、アメリカ、56001
        • 募集
        • Mayo Clinic Health Systems-Mankato
        • コンタクト：
        • コンタクト：
        • 主任研究者：
          • Jason T. Hayes, MD
      • Rochester、Minnesota、アメリカ、55905
        • 募集
        • Mayo Clinic in Rochester
        • 主任研究者：
          • Paul D. Brown, M.D.
        • コンタクト：
    • Wisconsin
      • Eau Claire、Wisconsin、アメリカ、54701
        • 募集
        • Mayo Clinic Health System-Eau Claire Clinic
        • コンタクト：
        • 主任研究者：
          • Now Bahar Alam, MD
        • コンタクト：
      • La Crosse、Wisconsin、アメリカ、54601
        • 募集
        • Mayo Clinic Health System-Franciscan Healthcare
        • コンタクト：
        • 主任研究者：
          • Abigail L. Stockham, MD
        • コンタクト：

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

18年歳以上 (大人、高齢者)

健康ボランティアの受け入れ

いいえ

受講資格のある性別

全て

説明

Inclusion Criteria:

  • Age >= 18 years old

  • 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

  • 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

  • Able to undergo contrast enhanced MRI brain

  • Negative urine or serum pregnancy test completed =< 7 days prior to registration, for women of childbearing potential only

  • 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

  • Eastern Cooperative Oncology Group (ECOG) performance score of (PS) >= 2

  • 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

  • Any brain metastasis that is located in the brainstem measuring >= 2.0 cm in maximal extent

  • 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

  • Any patient with an intact brain metastasis measuring > 4.0 cm

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：処理
  • 割り当て：ランダム化
  • 介入モデル：並列代入
  • マスキング：なし（オープンラベル）

武器と介入

参加者グループ / アーム
介入・治療
他の：Arm A (single fraction SRS)

Patients undergo single fraction SRS. Patients also undergo MRI at screening and during follow up.
手順：Magnetic Resonance Imaging

Undergo MRI

他の名前：
  • MRI
  • 磁気共鳴
  • 磁気共鳴画像スキャン
  • 氏
  • MRイメージング
  • MRI スキャン
  • NMRイメージング
  • NMRI
  • 医療画像処理
  • 磁気共鳴 / 核磁気共鳴
  • 核磁気共鳴イメージング
  • 磁気共鳴画像法 (MRI)
  • sMRI
  • 磁気共鳴画像法（手順）
  • 構造MRI
他の：Questionnaire Administration

Ancillary studies

放射線：Stereotactic Radiosurgery

Undergo single fraction SRS

他の名前：
  • 定位外部ビーム照射
  • 定位外照射療法
  • 定位放射線治療
  • 定位放射線手術
  • SRS
放射線：Stereotactic Radiosurgery

Undergo fractionated SRS

他の名前：
  • 定位外部ビーム照射
  • 定位外照射療法
  • 定位放射線治療
  • 定位放射線手術
  • SRS
他の：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.
手順：Magnetic Resonance Imaging

Undergo MRI

他の名前：
  • MRI
  • 磁気共鳴
  • 磁気共鳴画像スキャン
  • 氏
  • MRイメージング
  • MRI スキャン
  • NMRイメージング
  • NMRI
  • 医療画像処理
  • 磁気共鳴 / 核磁気共鳴
  • 核磁気共鳴イメージング
  • 磁気共鳴画像法 (MRI)
  • sMRI
  • 磁気共鳴画像法（手順）
  • 構造MRI
他の：Questionnaire Administration

Ancillary studies

放射線：Stereotactic Radiosurgery

Undergo single fraction SRS

他の名前：
  • 定位外部ビーム照射
  • 定位外照射療法
  • 定位放射線治療
  • 定位放射線手術
  • SRS
放射線：Stereotactic Radiosurgery

Undergo fractionated SRS

他の名前：
  • 定位外部ビーム照射
  • 定位外照射療法
  • 定位放射線治療
  • 定位放射線手術
  • SRS

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Time to local failure or symptomatic radiation brain necrosis of large brain metastasis
時間枠：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

二次結果の測定

結果測定
メジャーの説明
時間枠
Overall survival (OS)
時間枠：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
時間枠：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
時間枠：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)
時間枠：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
時間枠：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)
時間枠：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)
時間枠：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
時間枠：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
時間枠：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
時間枠：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

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

Mayo Clinic

捜査官

  • 主任研究者：Paul D. Brown, MD、Mayo Clinic in Rochester

出版物と役立つリンク

研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。

便利なリンク

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (実際)

2022年3月14日

一次修了 (推定)

2027年8月1日

研究の完了 (推定)

2027年8月1日

試験登録日

最初に提出

2022年1月11日

QC基準を満たした最初の提出物

2022年1月24日

最初の投稿 (実際)

2022年2月3日

学習記録の更新

投稿された最後の更新 (実際)

2026年10月1日

QC基準を満たした最後の更新が送信されました

2026年9月29日

最終確認日

2026年9月1日

詳しくは

本研究に関する用語

追加の関連 MeSH 用語

その他の研究ID番号

  • GMROR2163
  • NCI-2021-14230 (レジストリ識別子：CTRP (Clinical Trial Reporting Program))
  • 21-003768 (その他の識別子：Mayo Clinic Institutional Review Board)

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米国FDA規制医薬品の研究

はい

米国FDA規制機器製品の研究

いいえ

この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。

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