Clinical Trial: Cognitive Outcome After SRS or WBRT in Patients With Multiple Brain Metastases (CAR-Study B)

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: A Prospective Randomized Study to Compare Cognitive Outcome After Stereotactic Radiosurgery or Whole Brain Radiation Therapy in Patients With 11-20 Brain Metastases

Brief Summary:

Whole Brain Radiation Therapy (WBRT) has long been the mainstay of treatment for patients with multiple brain metastases (BM). Meanwhile, Gamma Knife radiosurgery (GKRS) has been increasingly employed in the management of multiple BM to spare healthy tissue. Hence, GKRS is expected to cause fewer cognitive side effects than WBRT. Treatment of multiple BM without cognitive side effects is becoming more important, as more patients live longer due to better systemic treatment options. There are no published randomized trials yet directly comparing GKRS to WBRT in patients with multiple BM, including objective neuropsychological testing.

CAR-Study B is a prospective randomized trial comparing cognitive outcome after GKRS or WBRT in eligible patients with 11-20 BM.


Detailed Summary:

CAR-Study B is a prospective randomized trial comparing cognitive outcome after GKRS or WBRT in eligible patients with 11-20 BM on a triple dose gadolinium-enhanced MRI-scan. Neuropsychological assessment will be performed at baseline and at 3, 6, 9, 12 and 15 months after treatment. Follow-up assessments will be combined with 3-monthly MRI-scans.

Patients will be randomized to either GKRS or WBRT. Groups will be balanced at baseline (prior to radiotherapy), taking into account several (stratification) factors that may influence cognitive functioning over time, such as: total tumor volume in the brain, systemic treatment, KPS, age, histology, and baseline HVLT-R total recall score.


Sponsor: Elisabeth-TweeSteden Ziekenhuis

Current Primary Outcome: Cognitive decline at 3 months [ Time Frame: 3 months ]

Cognitive decline is defined as a significant decline (5 point decrease from baseline based on the Reliable Change Index (RCI) with correction for practice effects) in HVLT-R Total Recall score (verbal learning and memory test) after treatment with either GKRS or WBRT in patients with 11-20 brain metastases at time of treatment initiation.


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Verbal memory [ Time Frame: Baseline and 3, 6, 9, 12 and 15 months post GKRS/WBRT ]
    Verbal memory is measured with the Hopkins Verbal Learning Test-Revised (HVLT-R)
  • Cognitive flexibility [ Time Frame: Baseline and 3, 6, 9, 12 and 15 months post GKRS/WBRT ]
    Cognitive flexibility is measured with the Controlled Oral Word Association (COWA)
  • Word Fluency [ Time Frame: Baseline and 3, 6, 9, 12 and 15 months post GKRS/WBRT ]
    Word Fluency is measured with the Controlled Oral Word Association (COWA)
  • Working memory [ Time Frame: Baseline and 3, 6, 9, 12 and 15 months post GKRS/WBRT ]
    Working memory is measured with the Wechsler Adult Intelligence Scale - Digit Span
  • Processing speed [ Time Frame: Baseline and 3, 6, 9, 12 and 15 months post GKRS/WBRT ]
    Processing speed is measured with the Wechsler Adult Intelligence Scale - Digit Symbol
  • Motor dexterity [ Time Frame: Baseline and 3, 6, 9, 12 and 15 months post GKRS/WBRT ]
    Motor dexterity is measured with the Grooved Pegboard (GP)
  • Health Related Quality Of Life (HRQOL) [ Time Frame: Baseline and 3, 6, 9, 12 and 15 months post GKRS/WBRT ]
    The Functional Assessment of Cancer Therapy-Brain (FACT-Br) is used to measure HRQOL.
  • Fatigue [ Time Frame: Baseline and 3, 6, 9, 12 and 15 months post GKRS/WBRT ]
    Fatigue is measured with the Multidimensional Fatigue Inventory (MFI).
  • Depression and anxiety [ Time Frame: Baseline and 3, 6, 9, 12 and 15 months post GKRS/WBRT ]
    Depression and anxiety are measured with the Hospital Anxiety and Depression Scale (HADS).
  • Median Overall Survival [ Time Frame: 12 months after GKRS/WBRT ]
    Overall survival is defined as the time in months from the start of treatment to the date of death or last contact if alive. Kaplan-Meier methods are used to estimate overall survival.
  • Local tumor control [ Time Frame: 12 months after GKRS/WBRT ]
    Local brain tumor control of the initial treated lesions is defined as a complete, partial, or stable response, or less than a 25% increase in diameter on contrast-enhanced MRI follow-up and not requiring resection. Any initial treated lesions increased by more than 25% in diameter on contrast-enhanced MRI or required resection will be considered a local failure.
  • Distant tumor control [ Time Frame: 12 months after GKRS/WBRT ]
    Distant brain tumor control is defined as the absence of any new brain metastases, distinct from the initial treated lesion(s), on follow-up MRI. The appearance of one or more new lesions in the brain by contrast-enhanced follow-up MRI is considered distant failure.


Original Secondary Outcome: Same as current

Information By: Elisabeth-TweeSteden Ziekenhuis

Dates:
Date Received: October 27, 2016
Date Started: February 2016
Date Completion: March 2019
Last Updated: November 1, 2016
Last Verified: November 2016