ReciDOPA: Contribution From PET-DOPA in Glioblastoma Re-irradiation
Study Details
Study Description
Brief Summary
ReciDOPA is a phase II, single-stage randomized, multicenter, prospective trial assessing the efficacy of an irradiation protocol based on Intensity-modulated radiation therapy with simultaneous-integrated boost guided by FDOPA-PET in patient with recurrent glioblastoma.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2 |
Detailed Description
Glioblastoma (GBM) is the most common cerebral tumor in adults. Despite well-conducted treatments including surgery, chemo-radiotherapy and chemotherapy according to the European Organisation for Research and Treatment of Cancer (EORTC) and National Cancer Institute of Canada Clinical Trials Group (NCIC) protocol, recurrences remain unavoidable within approximately 6 months and the overall survival rate of patients at 5 years is inferior to 10%.
In case of recurrence, a second surgery, radiotherapy under stereotaxic conditions, bevacizumab or other innovative techniques have been proposed. However, they are not yet considered as reference treatments, due to the absence of therapeutic trials definitively proving their efficacy.
Evaluation of GBM progression is based on MRI, corticosteroid intake and clinical status.However, positron emission tomography (PET) is an extremely relevant examination for differentiating between true progression and pseudo-progression. Indeed, an increase in the transfer of amino acids in 18 F-dihydroxyphenylalanine (FDOPA)-PET strongly suggests a recurrence. A local treatment can then be proposed by favoring surgery or, as an option, radiotherapy under stereotactic conditions. However, this treatment, even if it is well tolerated, has an efficacy which could be improved.
Often proposed option to improve efficacy of this radiation technic consists in increasing the dose of irradiation. This dose increase is often limited by the tolerance of nearby healthy tissue. It could however be possible with coupled techniques of intensity modulation and stereotaxy within the framework of an integrated boost (Simultaneous Integrated Boost - SIB). At each radiation session, the dose delivered to the tumor volume would be increased in the metabolic volume (BTV) detected by FDOPA-PET.
The objective of this study is to evaluate, in patients with recurrent glioblastoma, the efficacy of a dose increase using an SIB in a volume delineated with FDOPA-PET.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Simultaneous-integrated boost with Intensity-modulated radiation therapy (IMRT) Planning Target Volume (PTV) 37,5 Gray (Gy): 37,5 Gy in 6 fractions of 6,25 Gy at the rate of one fraction each 2 days Prescription isodose line (PIL) at 80%, corresponding to 30 Gy as total dose, or 5 Gy per fraction PTV SIB 45 Gy: 45,0 Gy in 6 fractions of 7,50 Gy at the rate of one fraction each 2 days PIL at 80% corresponding to 36 Gy as total dose, or 6 Gy per fraction |
Radiation: Simultaneous-integrated boost with IMRT
Simultaneous-integrated boost guided by FDOPA-PET
|
| No Intervention: Standard IMRT PTV 37,5 Gy: 37,5 Gy in 6 fractions of 6,25 Gy at the rate of one fraction each 2 days PIL at 80%, corresponding to 30 Gy as total dose, or 5 Gy per fraction No SIB |
Outcome Measures
Primary Outcome Measures
- To determine efficacy of simultaneous-integrated boost with IMRT guided by FDOPA PET on Recurrence free survival in patient with recurrent glioblastoma [up to 24 months]
Recurrence free survival: interval between the date of inclusion in the trial until the date of recurrence of irradiated site (or one of the irradiated sites, in case of multiple irradiation)
Secondary Outcome Measures
- To evaluate the percentage of recurrence of irradiated sites [up to 24 months]
Number of sites with recurrence over the number of irradiated sites
- To Characterize recurrence sites: classified either as distant, marginal or in-field [up to 24 months]
Recurrence will be described according to their localisation by comparing images at recurrence with the images used for dosimetry. A recurrence will be defined as " distant" is it appears outside of 80% isodose, as "marginal" if it cuts 80% isodose and as "in-field" if it is completely located in 80% isodose. The 80% isodose is the reference isodose used for radiation therapy prescription.
- To evaluate the percentage of Recurrence free survival at 6 months [At 6 months]
Interval between the date of inclusion in the trial until the date of recurrence of irradiated site (first recurrence, in case of multiple irradiation). Patients that are alive without recurrence at the end of the tiral will be censored
- To evaluate the percentage of Recurrence free survival at 12 months [at 12 months]
Interval between the date of inclusion in the trial until the date of recurrence of irradiated site (first recurrence, in case of multiple irradiation). Patients that are alive without recurrence at the end of the tiral will be censored
- To evaluate the Overall survival [From date of inclusion until the date of death from any cause, assessed up to 72 months]
Interval between the date of inclusion in the trial until the date of death whatever the cause. Patients that are alive without recurrence at the end of the tiral will be censored
- To evaluate the Tolerance of re-irradiation [up to 24 months]
Recording of toxicities (according to Common Terminology Criteria for Adverse Events v5 criteria) at each follow-up visit
- To Characterize PET parameters at recurrence and compare them to baseline parameters [up to 24 months]
Standardized Uptake Value (SUV) max
- To Characterize PET parameters at recurrence and compare them to baseline parameters [up to 24 months]
SUV mean
- To Characterize PET parameters at recurrence and compare them to baseline parameters [up to 24 months]
SUV peak
- To evaluate quality of Life at 2 months [At 2 months]
quality of life will be measure with QLQ (Quality of life questionnaire) C30 (Cancer 30items) questionaire
- To evaluate quality of Life at 2 months [At 2 months]
quality of life will be measure with QLQ - BN20 (Brain Neoplasms 20items) questionaire
- To evaluate quality of Life at 4 months [At 4 months]
quality of life will be measure with QLQ-C30 questionaire
- To evaluate quality of Life at 4 months [At 4 months]
quality of life will be measure with QLQ-BN20 questionaire
- To evaluate quality of Life at 6 months [At 6 months]
quality of life will be measure with QLQ-C30 questionaire
- To evaluate quality of Life at 6 months [At 6 months]
quality of life will be measure with QLQ-BN20 questionaire
- To evaluate quality of Life at 12 months [At 12 months]
quality of life will be measure with QLQ-C30 questionaire
- To evaluate quality of Life at 12 months [At 12 months]
quality of life will be measure with QLQ-BN20 questionaire
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age > 18 years
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Glioblastoma, World Health Organization (WHO) grade IV, histologically proven
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Performance status 0, 1 or 2
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Neurological status ≥ 2
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Past irradiation in previsional re-irradiated site or in the vicinity (5 to 7 cm)
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Radiological proven recurrence according to 1 and 2 criteria, Wen et al
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Remaining node after partial surgery post-recurrence
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1 to 3 recurrence site(s) < 35 mm in wide axis and separated by at least 5 mm
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Volume of each lesion < 35 mL
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Distance between recurrence node(s) and optic nerves (left and right), chiasma and/or cerebral trunk > 10 mm
Exclusion Criteria:
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Patient with contraindication to MRI or PET
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Glioblastomosis
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Pregnancy or breastfeeding
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Patient that do not understand French
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Patient without affiliation to the national or local social security
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Patients not able to comply to the protocol assessments for geographic, social or psychological reasons
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Minor or patients placed under guardianship or supervision
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Patients deprived of liberty
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Patients placed under judicial protection
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Patients that are not able to express their consent
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Institut de cancérologie Strasbourg Europe | Strasbourg | France | 67033 |
Sponsors and Collaborators
- Institut de cancérologie Strasbourg Europe
- Centre Georges François Leclerc
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2021-011