SATURNUS: Hypofractionated Versus Single Fraction Stereotactic Adjuvant Radiotherapy to the Resection Cavity of Brain Metastases
Study Details
Study Description
Brief Summary
This prospective, randomized, controlled, monocentric clinical phase III study focuses on stereotactic irradiation of resection cavities of brain metastases after surgical resection and seeks to demonstrate the superiority of fractionated irradiation schemes in terms of local control.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
There is a growing scientific focus on single fraction stereotactic (SRS) and hypofractionated stereotactic irradiation (HFSRT) after surgical resection of brain metastasis and its use is more frequently recommended in international guidelines. Despite intensive research, the optimal fractionation scheme and dose prescription for adjuvant irradiation of the resection cavity remains unclear.
Based on our own institutional data [Cit.1] and a recently published metaanalysis [Cit.2], we hypothesize that local control (LC) after HFSRT is superior compared to SRS in terms of LC. To evaluate the hypothesis in a prospective, randomized, controlled setting we designed the SATURNUS study.
A total of 126 patients will be randomized 1:1 to either HFSRT (dose 6-7 x 5 Gy) or SRS (dose 1 x 12-20 Gy). If further unresected brain metastases are present, they will be treated with SRS (1 x 14 - 22 Gy). Irradiation is carried out with a Gamma Knife or a Linear Accelerator. In line with current clinical practice, the choice of positioning method for SRS with the Gamma Knife (mask or stereotactic frame) is left to the patient. In the case of SRS with the Linear Accelerator or HFSRT, fixation is done with a mask as technically not otherwise feasible. Follow-up-MRI will be at least carried out 6 weeks and 3, 6, 9 and 12 months after treatment. Primary endpoint of the study is local control (LC) at the irradiated resection cavity after 12 months. Locoregional control (LRC) and overall survival (OS) as well as salvage-treatments, irradiation-associated toxicities (especially rate of radionecrosis) and quality-of-life parameters are investigated as secondary endpoints.
To the best of our knowledge, the SATURNUS study is the only randomized phase III study comparing different techniques of postoperative stereotactic radiotherapy after resection of brain metastases adequately powered to detect a superiority of HSFRT regarding LC.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Arm A: HSFRT Hypofractionated stereotactic radiotherapy to the resection cavity, dose prescription: 6-7 x 5 Gy |
Radiation: Hypofractionated stereotactic radiotherapy (HFSRT) versus single fraction stereotactic radiotherapy radiosurgery (SRS)
intervention description see above
|
| Active Comparator: Arm B: SRS Single fraction stereotactic radiotherapy to the resection cavity, dose prescription: 1 x 12-20 Gy |
Radiation: Hypofractionated stereotactic radiotherapy (HFSRT) versus single fraction stereotactic radiotherapy radiosurgery (SRS)
intervention description see above
|
Outcome Measures
Primary Outcome Measures
- Local control [12 months after adjuvant radiotherapy]
Local control at the resected site(s)
Secondary Outcome Measures
- LC [12 months after adjuvant radiotherapy]
Local control at all treated site(s)
- LRC [12 months after adjuvant radiotherapy]
Locoregional control=CNS progression free survival
- OS [12 months after adjuvant radiotherapy]
Overall survival
- Salvage-free survival [12 months after adjuvant radiotherapy]
Overall survival
- Intracranial salvage therapy [12 months after adjuvant radiotherapy]
Number and kind of intracranial salvage treatments
- Pseudoprogression [up to 12 months after adjuvant radiotherapy]
Rate of pseudoprogression
- Irradiation-related toxicity [up to 12 months after adjuvant radiotherapy]
according to CTCAE v4.03, especially rate of radionecrosis
- QoL [up to 12 months after adjuvant radiotherapy]
Quality of life according to EORTC QLQ-C30 and EORTC QLQ-B20
- Time to loss of independence [up to 12 months after adjuvant radiotherapy]
defined as decrease in Barthel index by > 20 points
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Histologically confirmed solid tumor disease
-
One to three resected brain metastases
-
Consent to perform adjuvant irradiation by an interdisciplinary tumor board
-
Completed wound healing
-
Resection within the last six weeks at the time of study inclusion
-
Diameter of the resection cavity ≤ 4 cm (on Planning MRI)
-
Age > 18 years
-
KPS > 60%
-
Adequate contraceptive measures for fertile women / men
-
Written informed consent (must be available before enrolment in the trial)
Exclusion Criteria:
-
Contraindication for repetitive contrast enhanced MRI
-
Leptomeningeal disease
-
Small cell histology, hematological malignancies and / or germ cell malignancies
-
Previous irradiation of the brain
-
Pregnant and lactating women
-
Inability to understand the character and consequences of the study
-
Withdrawal of consent
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Dept. Radiation Oncology | Munich | Bavaria | Germany | 81675 |
Sponsors and Collaborators
- Technische Universität München
Investigators
- Study Director: Maria Waltenberger, Technical University Munich, Germany
Study Documents (Full-Text)
None provided.More Information
Publications
- Akanda ZZ, Hong W, Nahavandi S, Haghighi N, Phillips C, Kok DL. Post-operative stereotactic radiosurgery following excision of brain metastases: A systematic review and meta-analysis. Radiother Oncol. 2020 Jan;142:27-35. doi: 10.1016/j.radonc.2019.08.024. Epub 2019 Sep 25.
- Specht HM, Kessel KA, Oechsner M, Meyer B, Zimmer C, Combs SE. HFSRT of the resection cavity in patients with brain metastases. Strahlenther Onkol. 2016 Jun;192(6):368-76. doi: 10.1007/s00066-016-0955-2. Epub 2016 Mar 10.
- RadOnc MRI TUM - 2