Whole brain radiotherapy (WBRT) after local treatment of brain metastases in melanoma patients: Statistical Analysis Plan

Serigne N Lo, Angela M Hong, Lauren E Haydu, Tasnia Ahmed, Elizabeth J Paton, Victoria Steel, George Hruby, Anh Tran, Rachael L Morton, Anna K Nowak, Janette L Vardy, Katharine J Drummond, Haryana M Dhillon, Catherine Mandel, Richard A Scolyer, Mark R Middleton, Bryan H Burmeister, John F Thompson, Gerald B Fogarty, Serigne N Lo, Angela M Hong, Lauren E Haydu, Tasnia Ahmed, Elizabeth J Paton, Victoria Steel, George Hruby, Anh Tran, Rachael L Morton, Anna K Nowak, Janette L Vardy, Katharine J Drummond, Haryana M Dhillon, Catherine Mandel, Richard A Scolyer, Mark R Middleton, Bryan H Burmeister, John F Thompson, Gerald B Fogarty

Abstract

Background: The WBRTMel trial is a multinational, open-label, phase III randomised controlled trial comparing whole brain radiotherapy (WBRT) to observation following local treatment of one to three melanoma brain metastases with surgery and/or stereotactic irradiation. The primary trial endpoint was to determine the effect of adding WBRT to local treatment on distant intracranial control, and the secondary endpoints were neurocognitive function, quality of life (QoL), performance status, overall survival, death from intracranial causes, death from melanoma and cost-effectiveness.

Objective: The objective of this update is to outline and publish the pre-determined statistical analysis plan (SAP) before the database lock and the start of analysis.

Methods: The SAP describes basic analysis principles, methods for dealing with a range of commonly encountered data analysis issues and the specific statistical procedures for analysing efficacy and safety outcomes. The SAP was approved after closure of recruitment and before completion of patient follow-up. It outlines the planned primary analyses and a range of subgroup and sensitivity analyses regarding the clinical and QoL outcomes. Health economic outcomes are not included in this plan but will be analysed separately. The SAP will be adhered to for the final data analysis of this trial to avoid analysis bias arising from knowledge of the data.

Results: The resulting SAP is consistent with best practice and will allow open and transparent reporting.

Conclusion: We have developed a SAP for the WBRTMel trial which will be followed to ensure high-quality standards of internal validity to minimise analysis bias.

Trial registration: ANZ Clinical Trials Registry, ACTRN12607000512426 . Registered on 9 October 2007. ClinicalTrials.gov, NCT01503827 . Registered on 4 January 2012. Trial group reference numbers ANZMTG 01.07, TROG 08.05.

Keywords: Brain; Melanoma; Metastases; Radiotherapy; Randomised trial; Whole brain radiotherapy.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

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Fig. 1
Trial schema

References

    1. Fogarty GB, Hong A, Dolven Jacobsen K, Reisse CH, Shivalingam B, Burmeister B, et al. Accrual to a randomised trial of adjuvant whole brain radiotherapy for treatment of melanoma brain metastases is feasible. BMC Res Notes. 2014;7:412. doi: 10.1186/1756-0500-7-412.
    1. Fogarty G, Morton RL, Vardy J, Nowak AK, Mandel C, Forder PM, et al. Whole brain radiotherapy after local treatment of brain metastases in melanoma patients—a randomised phase III trial. BMC Cancer. 2011;11:142. doi: 10.1186/1471-2407-11-142.
    1. Fogarty GB, Hong A, Dolven-Jacobsen K, Reisse CH, Burmeister B, Haydu LH, et al. First interim analysis of a randomised trial of whole brain radiotherapy in melanoma brain metastases confirms high data quality. BMC Res Notes. 2015;8:192. doi: 10.1186/s13104-015-1153-5.
    1. Gondi V, Pugh SL, Tome WA, et al. Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trials. J Clin Oncol. 2014;32(34):3810–3816. doi: 10.1200/JCO.2014.57.2909.
    1. Brandt R, Schretlen D, Groninger L, Brandt J. Hopkins Verbal Learning Test–Revised: normative data and analyses of inter-form and test-retest reliability. Clin Neuropsychol. 1998;12:43–55. doi: 10.1076/clin.12.1.43.1726.
    1. Levine AJ, Miller EN, Becker JT, Selnes OA, Cohen BA. Normative data for determining significance of test-retest differences on eight common neuropsychological instruments. Clin Neuropsychol. 2004;18:373–384. doi: 10.1080/1385404049052420.
    1. Ruff RM, Light RH, Parker SB, Levin HS. Benton Controlled Oral Word Association Test: reliability and updated norms. Arch Clin Neuropsychol. 1996;11:329–338. doi: 10.1093/arclin/11.4.329.
    1. Groenvold M, Klee MC, Sprangers MA, Aaronson NK. Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement. J Clin Epidemiol. 1997;50(4):441–450. doi: 10.1016/S0895-4356(96)00428-3.
    1. Taphoorn MJ, Claassens L, Aaronson NK, Coens C, Mauer M, Osoba D, Stupp R, Mirimanoff R, Van den Bent MJ, Bottomley A. The EORTC QLQ-BN20 questionnaire for assessing the health-related quality of life (HRQoL) in brain cancer patients: a phase IV validation on behalf of the EORTC QLG, BCG, ROG, NCIC-CTG. J Clin Oncology. 2008;26(15_suppl):2041. doi: 10.1200/jco.2008.26.15_suppl.2041.
    1. Herdman M, Gudex C, Lloyd A, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Qual Life Res. 2011;20(10):1727–1736. doi: 10.1007/s11136-011-9903-x.
    1. Carey CL, Woods SP, Rippeth JD, et al. Initial validation of a screening battery for the detection of HIV-associated cognitive impairment. Clin Neuropsychol. 2004;18:234–248. doi: 10.1080/13854040490501448.
    1. Carey CL, Woods SP, Gonzalez R, et al. Predictive validity of global deficit scores in detecting neuropsychological impairment in HIV infection. J Clin Exp Neuropsychol. 2004;26:307–319. doi: 10.1080/13803390490510031.
    1. Chang, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncology. 2009;10(11):1037–1044. doi: 10.1016/S1470-2045(09)70263-3.
    1. Mahmood U, et al. Whole-brain irradiation for patients with brain metastases: still the standard of care. Lancet Oncol. 2010;11(3):221–222. doi: 10.1016/S1470-2045(09)70389-4.
    1. Jennison C, Turnbull BW. Group sequential methods with applications to clinical trials. Washington, DC: Chapman & Hall/CRC; 2000.
    1. Pintilie M. Competing risks: a practical perspective. Chichester: John Wiley & Sons; 2007.
    1. Gray RJ. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–1154. doi: 10.1214/aos/1176350951.
    1. Norman R, Cronin P, Viney R. A pilot discrete choice experiment to explore preferences for EQ-5D-5L health states. Appl Health Econ Health Policy. 2013;11(3):287–298. doi: 10.1007/s40258-013-0035-z.
    1. McKenzie L, van der Pol M. Mapping the EORTC QLQ C-30 onto the EQ-5D instrument: the potential to estimate QALYs without generic preference data. Value Health. 2009;12(1):167–171. doi: 10.1111/j.1524-4733.2008.00405.x.
    1. Nooraee N, Molenberghs G, Ormel J, Van den Heuvel ER. Strategies for handling missing data in longitudinal studies with questionnaires. J Stat Comput Simul. 2018;88(17):3415–3436. doi: 10.1080/00949655.2018.1520854.
    1. International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) Expert Working Group . ICH Harmonised Tripartite Guideline: structure and content of clinical study reports E3. Geneva: ICH; 1995.

Source: PubMed

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