Principal Investigator
Enrollment Status
Clinical Trial ID
Clinical Trial Summary
This phase III trial studies how well single fraction stereotactic radiosurgery works
compared with fractionated stereotactic radiosurgery in treating patients with cancer that
has spread to the brain from other parts of the body and has been removed by surgery. Single
fraction stereotactic radiosurgery is a specialized radiation therapy that delivers a single,
high dose of radiation directly to the tumor and may cause less damage to normal tissue.
Fractionated stereotactic radiosurgery delivers multiple, smaller doses of radiation therapy
over time. This study may help doctors find out if fractionated stereotactic radiosurgery is
better or worse than the usual approach with single fraction stereotactic radiosurgery.
Phase
Phase 3
Funding Agency/Sponsor
National Cooperative Group
Disease
Neurological Cancer
Enrollment Eligibility
Inclusion Criteria:
PRE-REGISTRATION:
- Pathology from the resected brain metastasis must be consistent with a non-central
nervous system primary site. Patients with or without active disease outside the
nervous system are eligible (including patients with unknown primaries), as long as
the pathology from the brain is consistent with a non-central nervous system primary
site.
- Three or fewer (i.e. 0 to 3) unresected brain metastases (as defined on the post
operative magnetic resonance imaging [MRI]) at the time of screening.
o Note: Dural based metastases (e.g. commonly seen in breast cancer) are eligible.
- Unresected lesions must measure < 4.0 cm in maximal extent on the contrasted
post-operative treatment MRI brain scan. The unresected lesions will be treated with
SRS as outlined in the treatment section of the concept.
o Note: The metastases size restriction does not apply to the resected brain
metastasis.
- One brain metastasis must be completely (gross total resection) resected =< 30 days
prior to pre-registration.
o NOTE: May not have had resection of more than one brain metastasis.
- The resected brain metastasis must measure 2 cm or larger on the pre-operative MRI.
- Resection cavity must measure < 5.0 cm in maximal extent and the resection must be
complete (gross total resection) on the post-operative MRI obtained =< 30 days prior
to pre-registration.
- Karnofsky performance status of >= 60.
- For women of childbearing potential only, a negative urine or serum pregnancy test
done =< 7 days prior to pre-registration is required.
- Men and women of childbearing potential must be willing to employ adequate
contraception throughout the study and for men for up to 3 months after
completing treatment.
- A female of childbearing potential is a sexually mature female who: 1) has not
undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally
postmenopausal for at least 12 consecutive months (i.e., has had menses at any
time in the preceding 12 consecutive months).
- Ability to complete an MRI of the head with contrast.
- The brain metastasis must be located > 5 mm of the optic chiasm; the brain metastasis
must be located outside the brainstem (i.e. not inside the brainstem).
- Must not have any prior whole brain radiation therapy.
- Past radiosurgery to other lesions is allowed.
o NOTE: The surgically resected lesion cannot be the same location treated in the past
with radiosurgery (i.e. repeat radiosurgery to the same location/lesion is not allowed
on this protocol).
- May not have primary germ cell tumor, small cell carcinoma, or lymphoma.
- No evidence of leptomeningeal metastasis (LMD).
o NOTE: For the purposes of exclusion, LMD is a clinical diagnosis, defined as
positive cerebrospinal fluid (CSF) cytology and/or equivocal radiologic or clinical
evidence of leptomeningeal involvement. Patients with leptomeningeal symptoms in the
setting of leptomeningeal enhancement by imaging (MRI) would be considered to have LMD
even in the absence of positive CSF cytology, unless a parenchymal lesion can
adequately explain the neurologic symptoms and/or signs. In contrast, an asymptomatic
or minimally symptomatic patient with mild or nonspecific leptomeningeal enhancement
(MRI) would not be considered to have LMD. In that patient, CSF sampling is not
required to formally exclude LMD, but can be performed at the investigator's
discretion based on level of clinical suspicion.
- Must be fluent in English, Spanish, or French.
REGISTRATION:
• Completion of all baseline electronic patient-reported outcome (ePRO) quality of life
measures (or booklet quality of life measures) and Montreal Cognitive Assessment (MoCA).