Brain Metastasases, Brain (Nervous System) Cancers, SRS
Conditions
Brief summary
When cancer spreads to the brain, doctors often use a precise type of radiation therapy called stereotactic radiosurgery (SRS) to treat these tumors. This treatment can effectively control brain tumors while helping protect healthy brain tissue. However, when brain tumors or the areas where tumors were surgically removed are larger, treatment outcomes in terms of side effects and tumour control can become worse. Specifically, standard SRS on larger areas can have lower tumour control and higher risk of side effects, particularly a condition called radiation necrosis, which can cause swelling and damage in nearby healthy brain tissue. Currently at Sunnybrook, large brain tumors are typically treated with SRS spread over 5 daily treatments using a machine called a linear accelerator. While this approach works well for many patients, it may be possible to improve results by combining two different types of radiation therapy machines - the linear accelerator and another specialized machine called the Gamma Knife. In this study, the investigators want to test a new treatment approach where patients first receive 4 daily treatments using the linear accelerator, followed by a 1-2 week break, and then a final treatment using the Gamma Knife. The break between treatments allows the study doctors to take new scans and precisely target any remaining tumor, which may shrink during the break, thereby potentially reducing the amount of healthy brain tissue exposed to radiation. The Gamma Knife is also particularly good at delivering very precise radiation while sparing nearby healthy tissue. Lastly, there may be unique biological mechanisms between the two technologies that could be taken advantage of, by combining the technologies in the participant's treatment plan, to improve cancer control. The investigators believe this combined approach might help achieve better tumor control while reducing the risk of side effects compared to using just the linear accelerator. This study will help the investigators understand if this new treatment strategy is safe and effective for patients with large brain tumors or surgical cavities, and whether it leads to better outcomes than the current treatment approach.
Interventions
RADIATIONRadiation Therapy
Adaptive radiation therapy with GK boost
Sponsors
Sunnybrook Health Sciences Centre
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Presence of up to two large intracranial lesions * Up to 10 (previously untreated, or progressing after previous treatment) brain metastases at the time of enrollment on the diagnostic MRI (which includes the ILLs) to be treated with SRS/HSRS * Age =\> 18 years * Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 * Expected survival \>3 months * Patients that are deemed suitable for both GK and Linac based treatment * Patients that are able to hold systemic cancer chemotherapy/immunotherapy at least 2 days prior and following an SRS fraction
Exclusion criteria
* Prior SRS to the ILLs * Prior WBRT, or plan for concurrent WBRT with the protocol treatment * Presence or history of any leptomeningeal/pachymeningeal disease * Metastatic disease within the ventricles of the brain or corpus callosum * Small cell, hematopoietic or germ cell primaries * Patient with absolutely contraindications for MRI * Severe symptoms that preclude MRI or treatment using standard procedures for Linac or GK * Pregnant or lactating patient * Inability or unwillingness to undergo informed consent or post-treatment follow-up
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Cumulative incidence of late local complication (LLC) | From end of protocol treatment to development of local failure or symptomatic ISRS Grade => 2 radionecrosis (assessed up to 24 months) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Distant Brain Progression-Free Survival | Date of protocol treatment to either appearance of additional metastatic disease within the brain, or death (assessed up to 24 months) | — |
| Cumulative Incidence of Local Failure | Date of completion of protocol treatment to local failure (assessed up to 24 months) | — |
| Cumulative Incidence of Radiation Necrosis | Date of protocol treatment to development of symptomatic radiation necrosis (assessed up to 24 months) | — |
| Overall Survival | Completion of protocol treatment to date of death (assessed up to 24 months) | — |
| Change in Neurological Function | From enrollment onwards, up until 24 months after protocol treatment completion | Through changes in the NANO scale |
| Health-Related Quality of Life | From enrollment onwards, up until 24 months after protocol treatment completion | Through changes in responses to health-related quality of life surveys completed during study participation |
| Treatment-Related Toxicity | Throughout study participation and assessed up to 24 months following treatment completion | From changes to baseline, as defined by CTCAE v5.0 |
Countries
Canada
Contacts
Primary ContactHanbo Chan, MD
Backup ContactAimee Theriault
Outcome results
None listed