RAdiotherapy for Metastatic Spinal Cord Compression With Increased Radiation dosES (RAMSES-01)

  • STATUS
    Recruiting
  • End date
    Dec 31, 2022
  • participants needed
    65
  • sponsor
    University Hospital Schleswig-Holstein
Updated on 15 February 2022

Summary

This clinical study aims to investigate whether high-precision radiotherapy, as supposed, leads to a better control of the irradiated spinal cord metastases when compared to conventional radiotherapy. This means that a progression or recurrence of motor deficits (weakness) of the legs following radiotherapy can be avoided more effectively. Furthermore, the high-precision radiotherapy will be compared to the conventional radiotherapy with respect to pain relief, motor function/ability to walk, quality of life, side effects and survival.

Description

The aim of this single-arm study is to show that high-precision radiotherapy (RT) with 18x2.33 Gy in 3.5 weeks results in significantly better local progression free survival (LPFS) of metastatic spinal cord compression (MSCC) when compared to conventional RT with 10x3 Gy in 2 weeks. If such superiority could be shown, 18x2.33 Gy could be recommended, at least for those patients with favourable survival prognoses, since an in-field recurrence of MSCC in the irradiated part of the spine is generally very difficult to treat.

For this investigation the newly prospectively collected data will be compared with a historical cohort collected up to the time of data analysis.

The recruitment of all 65 patients (62 patients + 5% for potential drop-outs) is planned to be completed within 21 months. The follow-up period will be 12 months. This equals a total running time for the study of 33 months.

In accordance with a previous study assessing local control of MSCC, the following patient characteristics will be recorded to allow adequate comparison with the historical control

group
  • Age
  • Gender
  • Type of primary tumor (breast cancer vs. prostate cancer vs. myeloma/ lymphoma vs. lung cancer vs. other tumors)
  • Interval from tumor diagnosis to MSCC (15 months vs. >15 months)
  • Number of involved vertebrae (1-2 vs. 3)
  • Other bone metastases at the time of RT (no vs. yes)
  • Visceral metastases at the time of RT (no vs. yes)
  • Time developing motor deficits prior to RT (1-7 days vs. 8-14 days vs. >14 days)
  • Ambulatory status prior to RT (no vs. yes)
  • Eastern Cooperative Oncology Group (ECOG) performance score (0-2 vs- 3-4)
  • Indication for decompressive surgery of affected spinal areas

The patients of this study who received high-precision RT with 18x2.33 Gy for MSCC will be compared to a historical control group of patients with a favorable survival prognosis who were treated with 10x3 Gy of conventional RT. The historical control group will include data from 235 patients qualifying for the comparison with the prospectively collected data.

Data for the historical control group will be collected from an already existing anonymized database with previous study data documented in the European Union.

To be eligible for control group, patients fulfilling the same inclusion criteria and exclusion criteria as defined in the prospective study are considered. Furthermore, to be consistent with efficacy analysis of the study, patients of the historical control group must have received at least 80% of the planned RT dose.

Propensity score techniques will be applied to reduce confounding due to differences between the historical control group and the prospective trial data.

Details
Condition Spinal Cord Compression Due to Metastasis to Spine
Treatment High-precision RT
Clinical Study IdentifierNCT04043156
SponsorUniversity Hospital Schleswig-Holstein
Last Modified on15 February 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Motor deficits of the lower extremities resulting from MSCC, which have persisted for no longer than 30 days
Confirmation of diagnosis by MR-imaging (computed tomography [CT] allowed)
Age 18 years or older
Written informed consent
Favorable survival prognosis (defined as 36-45 points on the survival score)
Capacity of the patient to contract

Exclusion Criteria

Previous RT or surgery of the spinal areas affected by MSCC
Symptomatic brain tumor or symptomatic brain metastases
Metastases of the cervical spine only
Other severe neurological disorders
Pregnancy, Lactation
Clear indication for spinal surgery
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