Supramarginal Resection in Glioblastoma

NCT ID: NCT04243005

Last Updated: 2025-12-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-07-01

Study Completion Date

2030-03-31

Brief Summary

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Gliomas are the most common malignant brain tumor. Glioblastoma, WHO grade IV astrocytoma, is the most common subtype and unfortunately also the most aggressive subtype with median survival in population based cohorts being only 10 months. Extensive surgical resections followed by postoperative fractioned radiotherapy and concomitant and adjuvant temozolomide prolong survival and is the standard treatment.

The investigators think there is significant potential in individualized surgical decision-making in glioblastoma management. The idea that some patients are amendable to radical surgery, while others should be treated more conservatively, is not controversial in other fields of oncology. The current concept in all patients with glioblastoma is "maximum safe resection of the contrast enhancing tumor", but this may in selected cases be extended to simply "maximum safe resection" tailored to the patient and extent of disease at hand.

Densely proliferating tumor cells have been found from at an average of 10 mm beyond the margins of contrast enhancement in high-grade gliomas. There are now several case series, using various definitions of supramarginal resection, but they have in common that they report a benefit of resection with a margin. This potential benefit also comes together with an associated neurological risk, making this approach unethical and simply not feasible in the patients with glioblastoma as a whole.

Objective of this study is: To investigate if resection with a margin, that is significantly beyond the radiological contrast enhancement, improves survival in selected patients with glioblastoma.

Detailed Description

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Conditions

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Glioblastoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors
Participants will be masked until postoperative period. Outcome assessor will be masked until all predefined outcomes have been analysed

Study Groups

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Conventional surgery

Aim of gross total resection (i.e. removal of contrast enhancing tumor) according to institutional practice. No limit in use of technical adjuncts in this arm.

Group Type ACTIVE_COMPARATOR

Conventional surgery

Intervention Type PROCEDURE

Aim of gross total resection (i.e. removal of contrast enhancing tumor) according to institutional practice. No limit in use of technical adjuncts in this arm.

Supramarginal surgery

Aim of supramarginal resection, where a margin of at least 10 mm is considered feasible prior to surgery. The resection is guided by the T2 volume (i.e. zone of edema) where removal of as much as possible of this zone (or beyond) is attempted as long as considered safe

Group Type EXPERIMENTAL

Supramarginal resection

Intervention Type PROCEDURE

Aim of supramarginal resection, where a margin of at least 10 mm is considered feasible prior to surgery. The resection is guided by the T2 volume (i.e. zone of edema) where removal of as much as possible of this zone (or beyond) is attempted as long as considered safe

Interventions

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Supramarginal resection

Aim of supramarginal resection, where a margin of at least 10 mm is considered feasible prior to surgery. The resection is guided by the T2 volume (i.e. zone of edema) where removal of as much as possible of this zone (or beyond) is attempted as long as considered safe

Intervention Type PROCEDURE

Conventional surgery

Aim of gross total resection (i.e. removal of contrast enhancing tumor) according to institutional practice. No limit in use of technical adjuncts in this arm.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. A suspected diagnosis of supratentorial glioblastoma by MRI.(A)
2. Indication for surgical treatment and where supramarginal resection is considered possible according to the preoperative imaging. This consideration needs to be verified by two specialists in neurosurgery.
3. Negative work-up for other primary tumor(B)
4. Karnofsky performance status of 70 - 100.

A) If randomized to supramarginal surgery, intraoperative frozen section must conclude with "high-grade glioma" to be able to proceed. Surgery in two sessions is also possible in supramarginal group if there is no intraoperative frozen section available or frozen section indicate another diagnosis, but final histopathology reveals a glioblastoma. In case of surgery in two session, there must be no more than 30 days between procedures. See flow-chart in attachment 1.

B) No suspected primary tumor seen on CT chest, abdomen and pelvis. If relevant symptoms/clinical suspicion also supplement with mammography, dermatologist exam, relevant endoscopies etc.

Exclusion Criteria

1. Not willing to be randomized.
2. Informed consent not possible (e.g. language barriers, aphasia, cognitive severely impaired).
3. Contrast enhancement volume bilateral OR involving corpus callosum.
5. Contrast enhancement involving several lobes.
6. History of major psychiatric disorder such as psychosis, schizophrenia and/or mood disorder (e.g. depression and bipolar disorder) in need of hospitalization
7. Unfit for participation for any other reason judged by the including physician
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Odense University Hospital

OTHER

Sponsor Role collaborator

Sahlgrenska University Hospital

OTHER

Sponsor Role collaborator

Turku University Hospital

OTHER_GOV

Sponsor Role collaborator

Karolinska University Hospital

OTHER

Sponsor Role collaborator

Norwegian University of Science and Technology

OTHER

Sponsor Role collaborator

Uppsala University Hospital

OTHER

Sponsor Role collaborator

University Hospital, Umeå

OTHER

Sponsor Role collaborator

Haukeland University Hospital

OTHER

Sponsor Role collaborator

Ullevaal University Hospital

OTHER

Sponsor Role collaborator

Rikshospitalet University Hospital

OTHER

Sponsor Role collaborator

Tampere University Hospital

OTHER

Sponsor Role collaborator

Helsinki University Central Hospital

OTHER

Sponsor Role collaborator

Kuopio University Hospital

OTHER

Sponsor Role collaborator

Oulu University Hospital

OTHER

Sponsor Role collaborator

Medical University of Vienna

OTHER

Sponsor Role collaborator

Paracelsus Medical University

OTHER

Sponsor Role collaborator

Medical Center Haaglanden, The Hague, The Netherlands

UNKNOWN

Sponsor Role collaborator

Erasmus Medical Center

OTHER

Sponsor Role collaborator

St. Olavs Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Asgeir S Jakola, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

St.Olavs University Hospital and Sahlgrenska University Hospital

Geir Bråthen, MD, PhD

Role: STUDY_DIRECTOR

St. Olavs Hospital

Locations

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Medical University of Vienna

Vienna, , Austria

Site Status RECRUITING

Odense University Hospital

Odense, , Denmark

Site Status RECRUITING

Helsinki University Hospital

Helsinki, , Finland

Site Status RECRUITING

Kuopio University Hospital

Kuopio, , Finland

Site Status RECRUITING

Oulu University Hospital

Oulu, , Finland

Site Status RECRUITING

Tampere University Hospital

Tampere, , Finland

Site Status RECRUITING

Turku University Hospital

Turku, , Finland

Site Status RECRUITING

Erasmus MC

Rotterdam, , Netherlands

Site Status RECRUITING

Haaglanden MC

The Hague, , Netherlands

Site Status RECRUITING

Haukeland University Hospital

Bergen, , Norway

Site Status RECRUITING

Oslo University Hospital, Rikshospitalet

Oslo, , Norway

Site Status RECRUITING

Ullevål University Hospital

Oslo, , Norway

Site Status RECRUITING

St Olavs Hospital

Trondheim, , Norway

Site Status RECRUITING

Sahlgrenska University Hospital,

Gothenburg, , Sweden

Site Status RECRUITING

Karolinska University Hospital

Stockholm, , Sweden

Site Status RECRUITING

University Hospital of Umeå

Umeå, , Sweden

Site Status RECRUITING

Uppsala University Hospital

Uppsala, , Sweden

Site Status RECRUITING

Countries

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Austria Denmark Finland Netherlands Norway Sweden

Central Contacts

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Asgeir S Jakola, MD, PhD

Role: CONTACT

+47 72 57 30 00

Sasha Gulati, MD, PhD

Role: CONTACT

+47 72 57 30 00

Facility Contacts

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Georg Widhalm

Role: primary

Frants R Poulsen

Role: primary

Christian Bonde Pedersen

Role: backup

Jarno Satopää

Role: primary

Justiina Huhtakangas

Role: backup

Olli-Pekka Kämäräinen

Role: primary

Sami Tetri

Role: primary

Role: backup

Joonas Haapasalo

Role: primary

Ville Vuorinen

Role: primary

Jussi Posti

Role: backup

Arnaud Vincent, MD

Role: primary

Marike Broekman, MD

Role: primary

Ruby Mahesperan

Role: primary

Einar Vik-Mo

Role: primary

Eirik Helseth

Role: primary

Ole Solheim

Role: primary

Sasha Gulati

Role: backup

Asgeir S Jakola

Role: primary

Louise Carstam

Role: backup

Margret Jensdottir

Role: primary

Jiri Bartek jr

Role: backup

Rickard Sjöberg

Role: primary

Mats Ryttlefors

Role: primary

Other Identifiers

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2019/1046

Identifier Type: -

Identifier Source: org_study_id

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