Hypofractionated Versus Single Fraction Stereotactic Adjuvant Radiotherapy to the Resection Cavity of Brain Metastases

NCT ID: NCT05160818

Last Updated: 2021-12-16

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

126 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-02-01

Study Completion Date

2025-08-01

Brief Summary

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This prospective, randomized, controlled, monocentric clinical phase III study focuses on stereotactic irradiation of resection cavities of brain metastases after surgical resection and seeks to demonstrate the superiority of fractionated irradiation schemes in terms of local control.

Detailed Description

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There is a growing scientific focus on single fraction stereotactic (SRS) and hypofractionated stereotactic irradiation (HFSRT) after surgical resection of brain metastasis and its use is more frequently recommended in international guidelines. Despite intensive research, the optimal fractionation scheme and dose prescription for adjuvant irradiation of the resection cavity remains unclear.

Based on our own institutional data \[Cit.1\] and a recently published metaanalysis \[Cit.2\], we hypothesize that local control (LC) after HFSRT is superior compared to SRS in terms of LC. To evaluate the hypothesis in a prospective, randomized, controlled setting we designed the SATURNUS study.

A total of 126 patients will be randomized 1:1 to either HFSRT (dose 6-7 x 5 Gy) or SRS (dose 1 x 12-20 Gy). If further unresected brain metastases are present, they will be treated with SRS (1 x 14 - 22 Gy). Irradiation is carried out with a Gamma Knife or a Linear Accelerator. In line with current clinical practice, the choice of positioning method for SRS with the Gamma Knife (mask or stereotactic frame) is left to the patient. In the case of SRS with the Linear Accelerator or HFSRT, fixation is done with a mask as technically not otherwise feasible. Follow-up-MRI will be at least carried out 6 weeks and 3, 6, 9 and 12 months after treatment. Primary endpoint of the study is local control (LC) at the irradiated resection cavity after 12 months. Locoregional control (LRC) and overall survival (OS) as well as salvage-treatments, irradiation-associated toxicities (especially rate of radionecrosis) and quality-of-life parameters are investigated as secondary endpoints.

To the best of our knowledge, the SATURNUS study is the only randomized phase III study comparing different techniques of postoperative stereotactic radiotherapy after resection of brain metastases adequately powered to detect a superiority of HSFRT regarding LC.

Conditions

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Brain Metastases Resection Cavity

Keywords

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Brain Metastases Resection Cavity Radiotherapy Stereotactic Irradiation Gamma Knife

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

1:1 Parallel Assignment
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

The affiliation to the treatment arm will not be blinded to anyone except the study neuroradiologist.

Study Groups

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Arm A: HSFRT

Hypofractionated stereotactic radiotherapy to the resection cavity, dose prescription: 6-7 x 5 Gy

Group Type ACTIVE_COMPARATOR

Hypofractionated stereotactic radiotherapy (HFSRT) versus single fraction stereotactic radiotherapy radiosurgery (SRS)

Intervention Type RADIATION

intervention description see above

Arm B: SRS

Single fraction stereotactic radiotherapy to the resection cavity, dose prescription: 1 x 12-20 Gy

Group Type ACTIVE_COMPARATOR

Hypofractionated stereotactic radiotherapy (HFSRT) versus single fraction stereotactic radiotherapy radiosurgery (SRS)

Intervention Type RADIATION

intervention description see above

Interventions

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Hypofractionated stereotactic radiotherapy (HFSRT) versus single fraction stereotactic radiotherapy radiosurgery (SRS)

intervention description see above

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

* Histologically confirmed solid tumor disease
* One to three resected brain metastases
* Consent to perform adjuvant irradiation by an interdisciplinary tumor board
* Completed wound healing
* Resection within the last six weeks at the time of study inclusion
* Diameter of the resection cavity ≤ 4 cm (on Planning MRI)
* Age \> 18 years
* KPS \> 60%
* Adequate contraceptive measures for fertile women / men
* Written informed consent (must be available before enrolment in the trial)

Exclusion Criteria

* Contraindication for repetitive contrast enhanced MRI
* Leptomeningeal disease
* Small cell histology, hematological malignancies and / or germ cell malignancies
* Previous irradiation of the brain
* Pregnant and lactating women
* Inability to understand the character and consequences of the study
* Withdrawal of consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Technical University of Munich

OTHER

Sponsor Role lead

Responsible Party

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Stephanie Combs

Univ.-Prof. Dr. med. Stephanie E. Combs

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Maria Waltenberger

Role: STUDY_DIRECTOR

Technical University Munich, Germany

Locations

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Dept. Radiation Oncology

Munich, Bavaria, Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Maria Waltenberger

Role: CONTACT

Phone: +49-89-4140-8281

Email: [email protected]

Stephanie E Combs, Prof. Dr.

Role: CONTACT

Phone: +49-89-4140-4501

Email: [email protected]

Facility Contacts

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Stephanie E. Combs, Prof. Dr.

Role: primary

References

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Specht HM, Kessel KA, Oechsner M, Meyer B, Zimmer C, Combs SE. HFSRT of the resection cavity in patients with brain metastases. Strahlenther Onkol. 2016 Jun;192(6):368-76. doi: 10.1007/s00066-016-0955-2. Epub 2016 Mar 10.

Reference Type BACKGROUND
PMID: 26964777 (View on PubMed)

Akanda ZZ, Hong W, Nahavandi S, Haghighi N, Phillips C, Kok DL. Post-operative stereotactic radiosurgery following excision of brain metastases: A systematic review and meta-analysis. Radiother Oncol. 2020 Jan;142:27-35. doi: 10.1016/j.radonc.2019.08.024. Epub 2019 Sep 25.

Reference Type BACKGROUND
PMID: 31563407 (View on PubMed)

Waltenberger M, Bernhardt D, Diehl C, Gempt J, Meyer B, Straube C, Wiestler B, Wilkens JJ, Zimmer C, Combs SE. Hypofractionated stereotactic radiotherapy (HFSRT) versus single fraction stereotactic radiosurgery (SRS) to the resection cavity of brain metastases after surgical resection (SATURNUS): study protocol for a randomized phase III trial. BMC Cancer. 2023 Jul 29;23(1):709. doi: 10.1186/s12885-023-11202-9.

Reference Type DERIVED
PMID: 37516835 (View on PubMed)

Other Identifiers

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RadOnc MRI TUM - 2

Identifier Type: -

Identifier Source: org_study_id