Intraoperative Radiotherapy in Treating Spinal Metastases

NCT06093854 | Not Yet Recruiting

• 1 other identifier: 2022SL052
• Study Type: interventional
• Target: 132
• Locations: 1 country
• Sites: 1

Brief Summary

In order to provide theoretical evidence for the comprehensive and standardized treatment of spinal metastases with pathological fractures and/or spinal cord compression, the investigators conduct this trial to investigate the efficacy and safety of IORT and postoperative SBRT in adjuvant treatment of metastatic spinal tumors after posterior decompression surgery by recruiting patients with spinal metastases who met the inclusion criteria, and randomly divided them into the following treatment cohorts: 1) decompression surgery + IORT (15-20 Gy, 20-50min）; 2) decompression surgery and postoperative SBRT(30Gy, 5 fractions, 3 weeks).

Conditions

Spinal Metastases

Keywords

spinal metastases; intraoperative radiotherapy; stereotactic body radiotherapy; decompression surgery

Outcome Measures

Primary Outcomes (1)

• Local control rate

  The local control of tumor in the surgical field

  2 years

Secondary Outcomes (4)

• Health-related quality of life

  2 years

• Progression-free survival

  2 years

• Overall survival

  2 years

• Radiation-related complications

  2 years

Study Arms (2)

Decompression surgery + IORT

EXPERIMENTAL

Decompression surgery + IORT (15-20 Gy, 20-50min）

Radiation: Intraoperative radiotherapy (IORT)

Decompression surgery + postoperative SBRT

ACTIVE COMPARATOR

Decompression surgery + postoperative SBRT (30Gy, 5 fractions, 3 weeks)

Radiation: Stereotactic body radiotherapy (SBRT)

Interventions

Intraoperative radiotherapy (IORT) RADIATION

Intraoperative radiotherapy (IORT, 15-20 Gy, 20-50min)

Decompression surgery + IORT

Stereotactic body radiotherapy (SBRT) RADIATION

postoperative stereotactic body radiotherapy (SBRT, 30Gy, 5 fractions, 3 weeks)

Decompression surgery + postoperative SBRT

Eligibility Criteria

• Age: 35 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Clinical diagnosis of spinal metastases;
• Estimated survival time more than 3 months;
• The spinal instability neoplastic score (SINS) \>12;
• The general condition allows to recieve surgery;
• Single or multiple metastatic lesions with only one site presenting epidural spinal cord compression;
• signed informed consent.

You may not qualify if:

• Clinical diagnosis of primary spinal tumors;
• Presence of metastases in central nerve system;
• Isolated lesion undergoing en bloc resection;
• Mental disorder and/or intellectual dificiency;
• Refusing to accept follow-up;
• without signing informed consent.

Sponsors & Collaborators

• Shanghai Changzheng Hospital: lead

Study Sites (1)

Shanghai Changzheng Hospital

Shanghai, Shanghai Municipality, 200003, China

Location

Related Publications (14)

• Barzilai O, Laufer I, Yamada Y, Higginson DS, Schmitt AM, Lis E, Bilsky MH. Integrating Evidence-Based Medicine for Treatment of Spinal Metastases Into a Decision Framework: Neurologic, Oncologic, Mechanicals Stability, and Systemic Disease. J Clin Oncol. 2017 Jul 20;35(21):2419-2427. doi: 10.1200/JCO.2017.72.7362. Epub 2017 Jun 22.

  PMID: 28640703 BACKGROUND

• Laufer I, Rubin DG, Lis E, Cox BW, Stubblefield MD, Yamada Y, Bilsky MH. The NOMS framework: approach to the treatment of spinal metastatic tumors. Oncologist. 2013 Jun;18(6):744-51. doi: 10.1634/theoncologist.2012-0293. Epub 2013 May 24.

  PMID: 23709750 BACKGROUND

• Calvo FA. Intraoperative irradiation: precision medicine for quality cancer control promotion. Radiat Oncol. 2017 Feb 2;12(1):36. doi: 10.1186/s13014-017-0764-5.

  PMID: 28148287 BACKGROUND

• Vaidya JS, Bulsara M, Baum M, Alvarado M, Bernstein M, Massarut S, Saunders C, Sperk E, Wenz F, Tobias JS; TARGIT-A investigators. Intraoperative radiotherapy for breast cancer: powerful evidence to change practice. Nat Rev Clin Oncol. 2021 Mar;18(3):187-188. doi: 10.1038/s41571-021-00471-7. No abstract available.

  PMID: 33495552 BACKGROUND

• Barzilai O, McLaughlin L, Amato MK, Reiner AS, Ogilvie SQ, Lis E, Yamada Y, Bilsky MH, Laufer I. Predictors of quality of life improvement after surgery for metastatic tumors of the spine: prospective cohort study. Spine J. 2018 Jul;18(7):1109-1115. doi: 10.1016/j.spinee.2017.10.070. Epub 2017 Nov 6.

  PMID: 29122701 RESULT

• Patchell RA, Tibbs PA, Regine WF, Payne R, Saris S, Kryscio RJ, Mohiuddin M, Young B. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005 Aug 20-26;366(9486):643-8. doi: 10.1016/S0140-6736(05)66954-1.

  PMID: 16112300 RESULT

• Correia D, Moullet B, Cullmann J, Heiss R, Ermis E, Aebersold DM, Hemmatazad H. Response assessment after stereotactic body radiation therapy for spine and non-spine bone metastases: results from a single institutional study. Radiat Oncol. 2022 Feb 21;17(1):37. doi: 10.1186/s13014-022-02004-7.

  PMID: 35189919 RESULT

• Thibault I, Chang EL, Sheehan J, Ahluwalia MS, Guckenberger M, Sohn MJ, Ryu S, Foote M, Lo SS, Muacevic A, Soltys SG, Chao S, Gerszten P, Lis E, Yu E, Bilsky M, Fisher C, Schiff D, Fehlings MG, Ma L, Chang S, Chow E, Parelukar WR, Vogelbaum MA, Sahgal A. Response assessment after stereotactic body radiotherapy for spinal metastasis: a report from the SPIne response assessment in Neuro-Oncology (SPINO) group. Lancet Oncol. 2015 Dec;16(16):e595-603. doi: 10.1016/S1470-2045(15)00166-7.

  PMID: 26678212 RESULT

• Sahgal A, Myrehaug SD, Siva S, Masucci GL, Maralani PJ, Brundage M, Butler J, Chow E, Fehlings MG, Foote M, Gabos Z, Greenspoon J, Kerba M, Lee Y, Liu M, Liu SK, Thibault I, Wong RK, Hum M, Ding K, Parulekar WR; trial investigators. Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial. Lancet Oncol. 2021 Jul;22(7):1023-1033. doi: 10.1016/S1470-2045(21)00196-0. Epub 2021 Jun 11.

  PMID: 34126044 RESULT

• Myrehaug S, Sahgal A, Hayashi M, Levivier M, Ma L, Martinez R, Paddick I, Regis J, Ryu S, Slotman B, De Salles A. Reirradiation spine stereotactic body radiation therapy for spinal metastases: systematic review. J Neurosurg Spine. 2017 Oct;27(4):428-435. doi: 10.3171/2017.2.SPINE16976. Epub 2017 Jul 14.

  PMID: 28708043 RESULT

• Orecchia R, Veronesi U, Maisonneuve P, Galimberti VE, Lazzari R, Veronesi P, Jereczek-Fossa BA, Cattani F, Sangalli C, Luini A, Caldarella P, Venturino M, Sances D, Zurrida S, Viale G, Leonardi MC, Intra M. Intraoperative irradiation for early breast cancer (ELIOT): long-term recurrence and survival outcomes from a single-centre, randomised, phase 3 equivalence trial. Lancet Oncol. 2021 May;22(5):597-608. doi: 10.1016/S1470-2045(21)00080-2. Epub 2021 Apr 9.

  PMID: 33845035 RESULT

• Vaidya JS, Bulsara M, Saunders C, Flyger H, Tobias JS, Corica T, Massarut S, Wenz F, Pigorsch S, Alvarado M, Douek M, Eiermann W, Brew-Graves C, Williams N, Potyka I, Roberts N, Bernstein M, Brown D, Sperk E, Laws S, Sutterlin M, Lundgren S, Holmes D, Vinante L, Bozza F, Pazos M, Le Blanc-Onfroy M, Gruber G, Polkowski W, Dedes KJ, Niewald M, Blohmer J, McCready D, Hoefer R, Kelemen P, Petralia G, Falzon M, Baum M, Joseph D. Effect of Delayed Targeted Intraoperative Radiotherapy vs Whole-Breast Radiotherapy on Local Recurrence and Survival: Long-term Results From the TARGIT-A Randomized Clinical Trial in Early Breast Cancer. JAMA Oncol. 2020 Jul 1;6(7):e200249. doi: 10.1001/jamaoncol.2020.0249. Epub 2020 Jul 9.

  PMID: 32239210 RESULT

• Wenz F, Schneider F, Neumaier C, Kraus-Tiefenbacher U, Reis T, Schmidt R, Obertacke U. Kypho-IORT--a novel approach of intraoperative radiotherapy during kyphoplasty for vertebral metastases. Radiat Oncol. 2010 Feb 11;5:11. doi: 10.1186/1748-717X-5-11.

  PMID: 20149237 RESULT

• Bludau F, Welzel G, Reis T, Schneider F, Sperk E, Neumaier C, Ehmann M, Clausen S, Obertacke U, Wenz F, Giordano FA. Phase I/II trial of combined kyphoplasty and intraoperative radiotherapy in spinal metastases. Spine J. 2018 May;18(5):776-781. doi: 10.1016/j.spinee.2017.09.011. Epub 2017 Sep 28.

  PMID: 28962909 RESULT

MeSH Terms

Interventions

Radiosurgery

Intervention Hierarchy (Ancestors)

Radiotherapy; Therapeutics; Stereotaxic Techniques; Neurosurgical Procedures; Surgical Procedures, Operative; Investigative Techniques

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor, Chief Surgeon

Model Details: 1. Decompression surgery + IORT (15-20 Gy, 20-50min） 2. Decomression surgery + postoperative SBRT ( 30Gy, 5 fractions, 3 weeks)

Study Record Dates

• First Submitted: October 9, 2023
• First Posted: October 23, 2023
• Study Start: January 1, 2024
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): January 1, 2027
• Last Updated: October 23, 2023

Record last verified: 2023-10

Locations

CN (1)