Stereotactic Radiation Therapy With or Without Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases

NCT ID: NCT00377156

Last Updated: 2022-09-16

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

213 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-07-31

Study Completion Date

2019-12-15

Brief Summary

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RATIONALE: Stereotactic radiation therapy can send x-rays directly to the tumor and cause less damage to normal tissue. Radiation therapy uses high-energy x-rays to kill tumor cells. It is not yet known whether stereotactic radiation therapy is more effective with or without whole-brain radiation therapy in treating patients with brain metastases.

PURPOSE: This randomized phase III trial is studying stereotactic radiation therapy and whole-brain radiation therapy to see how well they work compared with stereotactic radiation therapy alone in treating patients with brain metastases.

Detailed Description

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OBJECTIVES:

Primary

* Compare the overall survival of patients with 1 to 3 cerebral metastases treated with stereotactic radiosurgery with vs without whole-brain radiotherapy.

Secondary

* Compare time to CNS (brain) failure in patients treated with these regimens.
* Compare quality of life, duration of functional independence, and long-term neurocognitive status of patients treated with these regimens.
* Compare post-treatment toxicity in these patients.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to age (18 to 59 vs 60 and over), extracranial disease (controlled for ≤ 3 months vs controlled for \> 3 months), and number of brain metastases (1 vs 2 vs 3). Patients are randomized to 1 of 2 treatment arms.

* Arm I: Patients undergo stereotactic radiosurgery (SRS).
* Arm II: Patients undergo SRS as in arm I. Within 14 days, patients then undergo whole-brain radiotherapy 5 days a week for 2.5 weeks.

Quality of life, functional independence, and neurocognitive status are assessed at baseline, at the beginning of each treatment, at weeks 6 and 12, and then at 6, 9, 12, 16, 24 , 36, 48, and 60 months.

PROJECTED ACCRUAL: A total of 238 patients will be accrued for this protocol.

Conditions

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Breast Cancer Cognitive/Functional Effects Lung Cancer Metastatic Cancer Prostate Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Arm I

Patients undergo stereotactic radiosurgery (SRS)

Group Type ACTIVE_COMPARATOR

stereotactic radiosurgery

Intervention Type RADIATION

Arm II

Patients undergo SRS as in arm I. Within 14 days, patients then undergo whole-brain radiotherapy 5 days a week for 2.5 weeks.

Group Type EXPERIMENTAL

radiation therapy

Intervention Type RADIATION

Patients undergo radiation therapy 5 days a week for 2.5 weeks

stereotactic radiosurgery

Intervention Type RADIATION

Interventions

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radiation therapy

Patients undergo radiation therapy 5 days a week for 2.5 weeks

Intervention Type RADIATION

stereotactic radiosurgery

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

DISEASE CHARACTERISTICS:

* Diagnosis of cerebral metastases meeting the following criteria:

* One to three presumed brain metastases
* Metastases must be from a histologically confirmed extracerebral site (e.g., lung, breast, prostate)

* Histologic confirmation may have been from the primary tumor site, from another metastatic site (e.g., osseous metastasis, adrenal metastasis), or from the metastatic brain lesion(s)
* Each lesion must measure less than 3.0 cm by contrast MRI of the brain performed within the past 21 days
* Lesions must not be within 5 mm of the optic chiasm or within the brainstem
* Eligibility for treatment with gamma knife or linear accelerator-based radiosurgery confirmed by a radiation oncologist
* No primary germ cell tumor, small cell carcinoma, or lymphoma
* No leptomeningeal metastases
* Hormone receptor status not specified

PATIENT CHARACTERISTICS:

* Male or female
* Menopausal status not specified
* ECOG performance status 0-2
* Not pregnant
* Negative pregnancy test
* Fertile patients must use effective contraception

* Male patients must continue to use contraception for 3 months after the completion of radiotherapy
* No pacemaker or other MRI-incompatible metal in the body
* No known allergy to gadolinium

PRIOR CONCURRENT THERAPY:

* More than 7 days since prior and no concurrent chemotherapy
* No prior cranial radiotherapy
* No prior resection of cerebral metastases
* Concurrent hormonal agents, steroids, and/or anticonvulsants allowed
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Alliance for Clinical Trials in Oncology

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Paul D. Brown, MD

Role: STUDY_CHAIR

Mayo Clinic

Locations

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Arizona Oncology-Deer Valley Center

Phoenix, Arizona, United States

Site Status

Arizona Oncology Services Foundation

Scottsdale, Arizona, United States

Site Status

Memorial Medical Center

Modesto, California, United States

Site Status

Kaiser Permanente - Division of Research - Oakland

Oakland, California, United States

Site Status

St. Joseph Hospital Regional Cancer Center - Orange

Orange, California, United States

Site Status

Rohnert Park Cancer Center

Rohnert Park, California, United States

Site Status

Kaiser Permanente Medical Center - Santa Clara Kiely Campus

Santa Clara, California, United States

Site Status

Kaiser Permanente Medical Center - Santa Rosa

Santa Rosa, California, United States

Site Status

University of Colorado Cancer Center at UC Health Sciences Center

Aurora, Colorado, United States

Site Status

Veterans Affairs Medical Center - Denver

Denver, Colorado, United States

Site Status

Mayo Clinic - Jacksonville

Jacksonville, Florida, United States

Site Status

Florida Hospital Cancer Institute at Florida Hospital Orlando

Orlando, Florida, United States

Site Status

Northside Hospital Cancer Center

Atlanta, Georgia, United States

Site Status

Saint Joseph's Hospital of Atlanta

Atlanta, Georgia, United States

Site Status

Northeast Georgia Medical Center

Gainesville, Georgia, United States

Site Status

Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler

Savannah, Georgia, United States

Site Status

Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center

Boise, Idaho, United States

Site Status

Northwest Community Hospital

Arlington Heights, Illinois, United States

Site Status

Via Christi Cancer Center at Via Christi Regional Medical Center

Wichita, Kansas, United States

Site Status

Lucille P. Markey Cancer Center at University of Kentucky

Lexington, Kentucky, United States

Site Status

Owensboro Mercy Medical Center

Owensboro, Kentucky, United States

Site Status

Ochsner Cancer Institute at Ochsner Clinic Foundation

New Orleans, Louisiana, United States

Site Status

Lowell General Hospital

Lowell, Massachusetts, United States

Site Status

Saint Vincent Hospital at Worcester Medical Center

Worcester, Massachusetts, United States

Site Status

Henry Ford Hospital

Detroit, Michigan, United States

Site Status

Josephine Ford Cancer Center at Henry Ford Hospital

Detroit, Michigan, United States

Site Status

West Michigan Cancer Center

Kalamazoo, Michigan, United States

Site Status

CCOP - Duluth

Duluth, Minnesota, United States

Site Status

Mayo Clinic Cancer Center

Rochester, Minnesota, United States

Site Status

CentraCare Clinic - River Campus

Saint Cloud, Minnesota, United States

Site Status

Cancer Institute of Cape Girardeau, LLC

Cape Girardeau, Missouri, United States

Site Status

Saint Luke's Cancer Institute at Saint Luke's Hospital

Kansas City, Missouri, United States

Site Status

Billings Clinic - Downtown

Billings, Montana, United States

Site Status

Immanuel Medical Center

Omaha, Nebraska, United States

Site Status

Seacoast Cancer Center at Wentworth - Douglass Hospital

Dover, New Hampshire, United States

Site Status

Elliot Regional Cancer Center at Elliot Hospital

Manchester, New Hampshire, United States

Site Status

Somerset Medical Center

Somerville, New Jersey, United States

Site Status

J. Phillip Citta Regional Cancer Center at Community Medical Center

Toms River, New Jersey, United States

Site Status

Carolinas Medical Center/Levine Cancer Institute

Charlotte, North Carolina, United States

Site Status

Blumenthal Cancer Center at Carolinas Medical Center

Charlotte, North Carolina, United States

Site Status

Cape Fear Valley Medical Center Cancer Center

Fayetteville, North Carolina, United States

Site Status

Coastal Carolina Radiation Oncology Center

Wilmington, North Carolina, United States

Site Status

Forsyth Regional Cancer Center at Forsyth Medical Center

Winston-Salem, North Carolina, United States

Site Status

Medcenter One Hospital Cancer Care Center

Bismarck, North Dakota, United States

Site Status

Sanford Bismarck Medical Center

Bismarck, North Dakota, United States

Site Status

Summa Center for Cancer Care at Akron City Hospital

Akron, Ohio, United States

Site Status

Cancer Care Center, Incorporated

Salem, Ohio, United States

Site Status

Cancer Treatment Center

Wooster, Ohio, United States

Site Status

Legacy Mount Hood Medical Center

Gresham, Oregon, United States

Site Status

Legacy Good Samaritan Hospital & Comprehensive Cancer Center

Portland, Oregon, United States

Site Status

Legacy Good Samaritan Hospital and Medical Center

Portland, Oregon, United States

Site Status

Geisinger Cancer Institute at Geisinger Health

Danville, Pennsylvania, United States

Site Status

Frankford Hospital Cancer Center - Torresdale Campus

Philadelphia, Pennsylvania, United States

Site Status

Cancer Centers of the Carolinas - Faris Road

Greenville, South Carolina, United States

Site Status

CCOP - Greenville

Greenville, South Carolina, United States

Site Status

Greenville Cancer Center of the Carolinas (CCOP)

Greenville, South Carolina, United States

Site Status

University of Texas Medical Branch

Galveston, Texas, United States

Site Status

Legacy Salmon Creek Medical Center

Vancouver, Washington, United States

Site Status

St. Vincent Hospital Regional Cancer Center

Green Bay, Wisconsin, United States

Site Status

All Saints Cancer Center at Wheaton Franciscan Healthcare

Racine, Wisconsin, United States

Site Status

Tom Baker Cancer Centre - Calgary

Calgary, Alberta, Canada

Site Status

Margaret and Charles Juravinski Cancer Centre

Hamilton, Ontario, Canada

Site Status

Princess Margaret Hospital

Toronto, Ontario, Canada

Site Status

CHUS-Hopital Fleurimont

Sherbrooke, Quebec, Canada

Site Status

Countries

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United States Canada

References

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Churilla TM, Ballman KV, Brown PD, Twohy EL, Jaeckle K, Farace E, Cerhan JH, Anderson SK, Carrero XW, Garces YI, Barker FG 2nd, Deming R, Dixon JG, Burri SH, Chung C, Menard C, Stieber VW, Pollock BE, Galanis E, Buckner JC, Asher AL. Stereotactic Radiosurgery With or Without Whole-Brain Radiation Therapy for Limited Brain Metastases: A Secondary Analysis of the North Central Cancer Treatment Group N0574 (Alliance) Randomized Controlled Trial. Int J Radiat Oncol Biol Phys. 2017 Dec 1;99(5):1173-1178. doi: 10.1016/j.ijrobp.2017.07.045. Epub 2017 Aug 5.

Reference Type DERIVED
PMID: 28939223 (View on PubMed)

Brown PD, Jaeckle K, Ballman KV, Farace E, Cerhan JH, Anderson SK, Carrero XW, Barker FG 2nd, Deming R, Burri SH, Menard C, Chung C, Stieber VW, Pollock BE, Galanis E, Buckner JC, Asher AL. Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial. JAMA. 2016 Jul 26;316(4):401-409. doi: 10.1001/jama.2016.9839.

Reference Type DERIVED
PMID: 27458945 (View on PubMed)

Related Links

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https://nctn-data-archive.nci.nih.gov/

Data Available: Select individual patient-level data from this trial can be requested from the NCTN/NCORP Data Archive

Other Identifiers

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NCCTG-N0574

Identifier Type: -

Identifier Source: secondary_id

ACOSOG-N0574

Identifier Type: -

Identifier Source: secondary_id

CDR0000499633

Identifier Type: REGISTRY

Identifier Source: secondary_id

NCI-2009-00653

Identifier Type: REGISTRY

Identifier Source: secondary_id

N0574

Identifier Type: -

Identifier Source: org_study_id

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