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Stereotactic Radiotherapy in Oligometastatic Brain Disease: a Randomised Phase III Study Comparing Hypofractionated Stereotactic Radiation Therapy (3*10 Gy) to the Historical Single-dose Radiosurgery (1*20 to 25 Gy) With Medico-economic Evaluation.

Study Purpose

Brain metastases (BM) are a common systemic cancer manifestation which incidence increases. Therapeutic options include whole-brain radiotherapy (WBRT), surgery, and stereotactic radiosurgery (SRS). The concept of "oligometastatic" cerebral disease (oligoBM) has emerged and led to consider alternative approaches. The main challenge is to preserve neurological function and independence the longest as possible. Stereotactic radiotherapy (SRT) has emerged as an alternative treatment modality for selected oligoBM patients. It allows to achieve the balance of tumour destruction and normal tissue preservation by precisely and accurately delivering a very high dose of radiation in one (SRS) or a few (HSRT) fractions to a limited, well-defined volume. However, no standard exists for decision-making between SRS and HSRT and this important question is being discussed in the recent literature. HSRT appears particularly interesting, assuming the patient convenience of few fractions, the normal tissue sparing achieved through focal irradiation, and the improved normal tissue tolerance of high dose radiation through fractionation. Common adverse effects of SRT are rare but can occasionally be serious, notably radionecrosis that may induce neurological deficits in patients. Although SRS is often less well-tolerated, it remains the mainstay of treatment. To investigators knowledge, SRS and HSRT have not been prospectively compared.

Recruitment Criteria

Accepts Healthy Volunteers

Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms

No
Study Type

An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.


An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.


Searching Both is inclusive of interventional and observational studies.

Interventional
Eligible Ages 18 Years and Over
Gender All
More Inclusion & Exclusion Criteria

Inclusion Criteria:

  • - Patients aged ≥ 18 years.
  • - WHO performance status 0 or 1; - Patient eligible for SRT after a multidisciplinary committee decision; Patient with BMs from radioresistant cancer (renal cell carcinoma, sarcoma, melanoma) is eligible.
  • - Patient having up to 5 BM of solid tumours with an histologically proven diagnoses; patients who have had a metastasectomy and having 1 to 4 BM lesions is eligible (ANOCEF recommendations); post-operative cavity must be treated by radiosurgery according to local procedures with respect of non-inclusion criteria* (cavity will not be analyzed for efficacy) - Presence of at least one and no more than 5 target lesions for SRT, measuring between 10 and 25 mm.
In the event of synchronous BM, lesions measuring less than 10mm or more than 25mm (1 to 4 lesions) will be treated at the discretion of the investigator.
  • - Max cumulative GTV of 30cm3.
  • - Normal complete blood count (CBC) - Absence of bleeding BM or meningeal carcinomatosis; - Symptomatic BM are allowed.
  • - DS-GPA score: - Renal cancer: DS-GPA 2,5 or more.
  • - Breast cancer: DS-GPA 2,5 or more.
  • - Melanoma: DS-GPA 1.5 or more.
  • - Gastro-instestinal (GI) cancer: DSGPA 3 or more.
  • - Adenocarcinoma lung cancer: DS-GPA 2 or more (DS-GPAmol) - Squamous lung cancer : DS-GPA 2,5 or more (DS-GPAmol) - For cancers where the DS-GPA score is not applicable, the patient is eligible if eligibility criteria are met.
  • - Patient with no concomitant systemic treatment; in case of ongoing systemic treatment, wash out period of 3-7 days before and after SRT, depending of drug and at the discretion of investigator; - Patient sufficiently cooperating to perform the treatment with the use of a thermoformed mask; - Patient whose neuropsychological abilities allow to follow the requirements of the protocol; - Female with childbearing potential must use adequate contraception.
  • - Signed informed consent formOligoBM-01 Trial - ID-RCB number: 2021-A01622-39 - version 3.1 dated from 2023-06-22 Page 9 of 51.
  • - Patients affiliated to the social security system.

Exclusion Criteria:

  • - Patients with current or past history small cell lung cancer, germ-cell tumours, lymphoma, leukemia and multiple myeloma within the last 5 years; - Patients with metastases in the brain stem, or within 1 cm of the optic apparatus; - Patients with an associated neurodegenerative disease; - Any symptoms not attributable to BM or cancer disease requiring long term corticosteroid use (regardless of dose); - Contraindication to perform the brain MRI or gadolinium or iodinated contrast; - Known hypersensitivity to the contrast product or to any their excipients.
  • - Patients with previous brain stereotactic irradiation.
  • - Whole brain irradiation history; - Haemorrhagic metastasis; - Ongoing anti angiogenic treatment (treatment should be held 3-7 days before irradiation and re-initiated 3-7 days after irradiation for patient to be eligible); - Patients with too close brain lesions for whom a treatment plan on one target metastasis delivers a dose > 5 Gy on other concomitant metastasis ; - Patient deprived of liberty or under guardianship; - Known pregnancy or breastfeeding.
  • - Any geographical conditions, social and associated psychopathology that may compromise the patient's ability to participate in the study; - Participation in a therapeutic trial for less than 30 days.
- Patient deprived of freedom or under guardianship

Trial Details

Trial ID:

This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.

NCT05102747
Phase

Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.

Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.

Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.

Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.

N/A
Lead Sponsor

The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.

Centre Francois Baclesse
Principal Investigator

The person who is responsible for the scientific and technical direction of the entire clinical study.

N/A
Principal Investigator Affiliation N/A
Agency Class

Category of organization(s) involved as sponsor (and collaborator) supporting the trial.

Other
Overall Status Active, not recruiting
Countries France
Conditions

The disease, disorder, syndrome, illness, or injury that is being studied.

Brain Metastasis, Oligoprogression
Arms & Interventions

Arms

Experimental: Hypofractionated SRT (stereotactic radiotherapy)

Active Comparator: Historical single-dose SRS (stereotactic radiosurgery)

Interventions

Radiation: - Hypofractionated SRT (stereotactic radiotherapy)

3*10Gy over 1 week

Radiation: - Historical single-dose SRS (stereotactic radiosurgery)

20 to 25Gy/1 fraction

Contact a Trial Team

If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.

International Sites

CHU, Bordeaux, France

Status

Address

CHU

Bordeaux, ,

Institut Bergonié, Bordeaux, France

Status

Address

Institut Bergonié

Bordeaux, ,

CHU, Brest, France

Status

Address

CHU

Brest, ,

Centre François Baclesse, Caen, France

Status

Address

Centre François Baclesse

Caen, , 14076

CHU, Grenoble, France

Status

Address

CHU

Grenoble, ,

Centre Guillaume le Conquérant, Le Havre, France

Status

Address

Centre Guillaume le Conquérant

Le Havre, ,

Centre Oscar Lambret, Lille, France

Status

Address

Centre Oscar Lambret

Lille, ,

Groupe hospitalier Bretagne Sud, Lorient, France

Status

Address

Groupe hospitalier Bretagne Sud

Lorient, ,

Centre Antoine Lacassagne, Nice, France

Status

Address

Centre Antoine Lacassagne

Nice, ,

La Pitié Salpétrière, Paris, France

Status

Address

La Pitié Salpétrière

Paris, ,

Centre hospitalier Lyon Sud, Pierre-Bénite, France

Status

Address

Centre hospitalier Lyon Sud

Pierre-Bénite, ,

Centre Eugène Marquis, Rennes, France

Status

Address

Centre Eugène Marquis

Rennes, ,

Centre Henri Becquerel, Rouen, France

Status

Address

Centre Henri Becquerel

Rouen, ,

Saint Doulchard, France

Status

Address

Centre d'Oncologie et Radiothérapie Saint-Jean

Saint Doulchard, ,

Institut Claudius Regaud, Toulouse, France

Status

Address

Institut Claudius Regaud

Toulouse, ,

Gustave Roussy, Villejuif, France

Status

Address

Gustave Roussy

Villejuif, ,

Resources

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  • Research Resources
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The content provided on clinical trials is for informational purposes only and is not a substitute for medical consultation with your healthcare provider. We do not recommend or endorse any specific study and you are advised to discuss the information shown with your healthcare provider. While we believe the information presented on this website to be accurate at the time of writing, we do not guarantee that its contents are correct, complete, or applicable to any particular individual situation. We strongly encourage individuals to seek out appropriate medical advice and treatment from their physicians. We cannot guarantee the availability of any clinical trial listed and will not be responsible if you are considered ineligible to participate in a given clinical trial. We are also not liable for any injury arising as a result of participation.

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