Radiosurgery With or Without Whole Brain Radiation for Multiple Metastases

Launched by SUNNYBROOK HEALTH SCIENCES CENTRE · Dec 12, 2018

Keywords

ClinConnect Summary

This clinical trial is studying two treatment options for patients with multiple brain metastases, which are cancerous growths that have spread to the brain from other parts of the body. The trial will compare the effects of stereotactic radiosurgery (SRS), a precise form of radiation therapy that targets tumors in the brain, alone, versus SRS combined with whole brain radiation therapy (WBRT), which treats the entire brain. The goal is to see which approach is more effective for patients who have 5 to 30 brain metastases.

To participate in the trial, patients need to be at least 18 years old and have a confirmed diagnosis of a non-blood cancer with a specific number of brain metastases. They should also be able to understand and speak English well enough to complete important questionnaires about their health and quality of life. Participants can expect to receive their assigned treatment within four weeks of joining the study, and they will be closely monitored for their health and any side effects throughout the trial. It's important for potential participants to know that certain prior treatments or medical conditions may prevent them from joining the trial, and they will need to sign a consent form to confirm their willingness to participate.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Histologic or cytologic diagnosis of non-hematopoietic malignancy (excluding germ cell malignancies and small cell carcinoma).
• • Patients with ≥ 5 but ≤ 30 de novo brain metastases seen on a diagnostic-quality contrast-enhanced MRI obtained within 30 days prior to enrollment (or randomization if previously randomized). Patients who are found to have 31-50 metastatic lesions at the time of treatment planning may still participate in the study. Disease progression such that \> 50 brain metastases are detected after initial MRI prior to enrollment but before SRS will be treated off-protocol as per discretion of the treating physician.
• • Patients with ≥ 5 but ≤ 30 new brain metastases who have undergone prior SRS for 4 or less brain metastases with stable intracranial disease as per diagnostic MRI for at least 6 months post last course of SRS. Patients who are found to have 31-50 new metastatic lesions at the time of treatment planning may still participate in the study. Disease progression such that \> 50 new brain metastases are detected after initial MRI prior to enrollment but before SRS will be treated off-protocol as per discretion of the treating physician.
• • Age ≥ 18.
• • Karnofsky Performance Status (KPS) ≥ 70.
• • Baseline HVLT-R above ≥ 6
• • Patients must be able to tolerate WBRT, and all brain lesions must be eligible for treatment with SRS as determined by the radiation oncologist.
• • Patient consent must be appropriately obtained in accordance with applicable local and regulatory requirements. Each patient must sign a consent form prior to enrollment in the trial to document their willingness to participate.
• • Patient is able to read, speak, and understand (i.e. sufficiently fluent) English in order to allow completion and meaningful analyses of the neurocognitive tests and quality of life questionnaires.
• • Patients must be accessible for treatment and follow up. Investigators must assure themselves the patients registered on this trial will be available for complete documentation of the treatment, adverse events, and follow-up.
• • Patients who are on immunotherapy must have immunotherapy held at least 1 week before and after completion of radiotherapy. Other targeted agents/therapy must be held at least 1 day before and after SRS. Systemic chemotherapy must be held one week prior to treatment and re-started one week after treatment is complete.
• • Protocol treatment is to begin within 4 weeks of patient enrollment (or randomization if previously randomized).
• Exclusion Criteria:
• • Patients with brain metastases resulting from germ cell malignancies, small cell carcinoma, or hematologic malignancies.
• • Prior SRS for 5 or more brain metastases or any SRS for brain metastases within the last 6 months.
• • Any prior WBRT or radiotherapy for brain metastases such that the study interventions cannot be delivered.
• • Prior surgical resection of metastatic cancer from the brain.
• • Patients with evidence of leptomeningeal disease.
• • Patients who have a pacemaker or other contraindications, such that gadolinium-enhanced MRI cannot be performed or treatment cannot be delivered safely.
• • Patients who have received chemotherapy or immunotherapy within 1 week prior to administration of protocol radiotherapy or who are expected / planned to receive chemotherapy within one week of completing protocol radiotherapy.
• • Patients with \< 5 or \> 30 de novo or new brain metastases at time of enrollment, or \> 50 brain metastases at time of treatment planning.
• • Patients who are pregnant (women of child-bearing age must have negative pregnancy urine test within 7 days of enrollment or randomization).