Brain Metastasis, Ependymoma, Lung Tumors, Spinal Tumors
Conditions
Keywords
Pediatrics, SBRT, Brain metastasis, Pulmonary metastasis, Spinal metastasis, Pulmonary primary tumor, Spinal primary tumor, Relapsed ependymoma, Relapsed irradiated tumors, Local control rate, Safety, Overall survival, Progression Free Survival
Brief summary
The purpose of this study is to evaluate the efficacy of hypofractionated stereotactic radiation treatments (SBRT) on children, teenagers and young adults malignant tumors.
Detailed description
SBRT (Stereotactic Body Radiation Therapy) is a radiotherapy treatment which involves the delivery of a single high dose radiation treatment or a few fractionated radiation treatments (usually up to 5). A high potent biological dose of radiation is delivered to the tumor improving the cure rates for the tumor, in a manner previously not achievable by standard conventional radiation therapy. For adult patients, the Haute Authorité de Santé (HAS) validates some indications for this treatment which are the followings : * Few primary or secondary brain tumors, which cannot be surgically removed * Spinal tumors * Primary bronchopulmonary tumors T1 T2 N0 M0 and pulmonary metastasis with slow growth and controled primary tumor. For pediatrics patients, no indication is now validated by HAS. Indications validated for adults are rare in pediatrics but not exceptional, and in such cases efficient alternative treatments does not exist. In consequence, and regarding the good results obtained in adult patients, it seems very important to validate the efficacy of this treatment on pediatrics population
Interventions
RADIATIONSBRT treatment
For Brain metastasis the SBRT treatment consists on 3 fractions of 8 Gy or 5 fractions of 7 Gy or 1 fraction of 18 Gy for a single metastasis which is less than 20 mm. For primary or secondary pulmonary tumors the SBRT treatment consists on 3 fractions of 15 Gy or 5 fractions of 10 Gy for peripheral lesions and on 5 fractions of 8 Gy for proximal lesions. For primary or secondary spinal or para-spinal tumors the SBRT treatment consists on 3 fractions of 9 Gy or 5 fractions of 7 Gy. For previously irradiated tumors (same locations) the SBRT treatment consists on 5 to 8 fractions of 5 Gy. For relapsed Ependymoma previously irradiated the SBRT treatment will be allocated by surgical stratified randomization and consists on either 3 fractions of 8 Gy or 5 fractions of 5 Gy.
Sponsors
Centre Leon Berard
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Months to 20 Years
Healthy volunteers
No
Inclusion criteria
* 18 months ≤ age ≤ 20 years * Malignant primary tumor, histologically or cytologically proven * Systemic disease under control or with slow evolution * Written indication of SBRT according to local pediatrics meeting and national Radiotherapy (RT) web conference * Performance Status ≤ 2 according to Eastern Cooperative Oncology Group (ECOG) * Sites * Brain metastasis (≤ 3 on MRI) not suitable for surgery, without hemorrhage, less than 3 cm each, not in the brain stem * Primary or secondary spinal/para spinal metastasis (≤ 3), not suitable for surgery or with a non operable macroscopic residue, less than 5 cm * Lung metastasis (≤ 3), less than 5 cm, not eligible for surgery, or macroscopic residue not suitable for surgery * Previously irradiated relapsing isolated primitive/secondary tumor (intra cranial or extra cranial), with no possible surgery, or macroscopic residue. * Affiliation to a social security scheme * Signed Informed consent by patient or parents and patient IN ADDITION FOR RELAPSING EPENDYMOMA: * Histologically proven local ependymoma at diagnosis * Previously irradiated ependymoma * Exclusive local relapse in previously irradiated site * Review of operability at time of relapse by a multidisciplinary staff * Relapse must be confirmed by a neuro-oncology multidisciplinary staff, on MRI evolutivity characteristics * Time to relapse after previous irradiation ≥ 1 year NON-INCLUSION CRITERIA : * Concomitant chemotherapy * No evaluable target (except for completely resected ependymomas) * Pregnancy * Follow-up impossible IN ADDITION FOR RELAPSING EPENDYMOMAS: * Metastatic patient at diagnosis and/or at relapse * Complete remission never obtained NON-RANDOMIZATION DOSIMETRIC CRITERIA (ONLY FOR EPENDYMOMA) * Cumulative doses to brain stem ≥ 115 Gy * Tumor volume at relapse ≥ 30 cm3 * Primary RT dose + Re-irradiation dose more than 112 Gy * Cumulative dose to the chiasma \> 54 Gy * Cumulative dose to any point of the brain \> 115 Gy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy of SBRT assessed 6 months after treatment | 6 months after inclusion | The treatment efficacy is assessed by calculation of local control rate of irradiated locations according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 criteria (complete response + partial response + stable disease) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | From the date of inclusion to the date of death (Up to 5 years since the first inclusion) | Calculated from the date of inclusion to the date of death from any cause (Up to 5 years since the first inclusion) |
| Long term Safety profile of SBRT | after 24 months after inclusion | Toxicities appeared after 24 months after inclusion. The outcome measure concerns toxicities appeared after the study following period. Toxicities will be assessed by the evaluation of intensity and incidence of the Adverse Events (AE) displayed by patients. The intensity of each AE will be classified according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 |
| Efficacy of SBRT assessed 12 months after treatment | 12 months after inclusion | The treatment efficacy is assessed by calculation of local control rate of irradiated locations according to RECIST version 1.1 criteria (complete response + partial response + stable disease) at 12 months after treatment |
| Efficacy of SBRT assessed 24 months after treatment | 24 months after inclusion | The treatment efficacy is assessed by calculation of local control rate of irradiated locations according to RECIST version 1.1 criteria (complete response + partial response + stable disease) at 24 months after treatment |
| Medium time Safety profile of SBRT | Between 3 months and 24 months after inclusion | Toxicities appeared between 3 months and 24 months after treatment. Toxicities will be assessed by the evaluation of intensity and incidence of the Adverse Events (AE) displayed by patients. The intensity of each AE will be classified according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 |
| Efficacy of SBRT assessed between 1,5 and 3 months after treatment | Between 1,5 and 3 months after inclusion | The treatment efficacy is assessed by calculation of local control rate of irradiated locations according to RECIST version 1.1 criteria (complete response + partial response + stable disease) between 1,5 and 3 months after treatment |
| Progressive Free Survival | From the date of inclusion to the date of progression | Calculated from the date of inclusion to the date defined as the first documented disease progression, or second cancer appearance, or death from any cause (Up to 5 years since the first inclusion) |
| Short time Safety profile of SBRT | From inclusion to 3 months after inclusion | Toxicities appeared during SBRT treatment and up to 3 months after SBRT. Toxicities will be assessed by the evaluation of intensity and incidence of the Adverse Events (AE) displayed by patients. The intensity of each AE will be classified according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 |
Other
| Measure | Time frame | Description |
|---|---|---|
| Cost/Efficacy ratio between 2 modalities of SBRT treatment of ependymoma at 12 months after treatment | 12 months after inclusion | 2 modalities of SBRT are compared in patients with an ependymoma (3 fractions of 8 Gy versus 5 fractions of 5 Gy). It will be calculated : * the cost/efficacity per gained year of life without relapse after 12 months after SBRT * the cost/efficacity per gained year of life without disease after 12 months after SBRT. The costs will be evaluated by the data from french social security system, from homogeneous group of patients and from general classification of professional acts |
| Cost/Efficacy ratio between 2 modalities of SBRT treatment of ependymoma at 24 months after treatment | 24 months after inclusion | 2 modalities of SBRT are compared in patients with an ependymoma (3 fractions of 8 Gy versus 5 fractions of 5 Gy). It will be calculated : * the cost/efficacity per gained year of life without relapse after 24 months after SBRT * the cost/efficacity per gained year of life without disease after 24 months after SBRT. The costs will be evaluated by the data from french social security system, from homogeneous group of patients and from general classification of professional acts |
| SBRT treatment and toxicities related costs for 6 months after SBRT | 6 months after inclusion | The SBRT treatment related costs will be evaluated by a microcosting method which take into account, in particular, the irradiation duration seance, the time for the mobilized staff, the kind of equipment required, the duration of related AE hospitalizations. |
| Cost/Efficacy ratio between 2 modalities of SBRT treatment of ependymoma at 6 months after treatment | 6 months after inclusion | 2 modalities of SBRT are compared in patients with an ependymoma (3 fractions of 8 Gy versus 5 fractions of 5 Gy). It will be calculated the cost/efficacity ratio for the avoided toxicity 6 months after SBRT. The costs will be evaluated by the data from french social security system, from homogeneous group of patients and from general classification of professional acts |
Countries
France
Outcome results
None listed