Phase 2 Trial in Multiple Brain Metastases Outcomes With HA-SIB-WBRT

  • End date
    Jun 14, 2024
  • participants needed
  • sponsor
    National Cancer Centre, Singapore
Updated on 24 January 2021
brain tumor
stereotactic radiosurgery
whole-brain radiotherapy


Recently, the evidence supports hippocampal avoidance with whole brain radiotherapy (HA-WBRT) as the recommended treatment option in patients with good prognosis and multiple brain metastases as it gives better neurocognitive preservation compared to historical whole brain radiotherapy controls. There is however often poor tumour control with this technique due to the low doses given. Stereotactic Radiosurgery (SRS), a form of focused radiotherapy which is given to patients who have a limited number of brain metastases, gives a higher radiation dose to the metastases resulting in better target lesion control. With improvements in radiation technology, advanced dose-painting techniques now allow a simultaneous integrate boost (SIB) dose to lesions whilst minimising doses to the hippocampus to potentially improve brain tumour control and preserve cognitive outcomes (HA-SIB-WBRT).

The Investigators believe that the SIB in HA-SIB-WBRT (experimental) will result in better functional and survival outcomes compared to HA-WBRT (control). Patients who are fit, have multiple brain metastases (5-25 lesions) and reasonable life expectancy (>6 months) will be recruited from NCCS over 2 years. Patients will be followed up the over the following year with imaging, toxicity data, quality of life, activities of daily living and cognitive measurements at set time points. The results will be compared across the 2 arms.

Patients with brain metastases are living longer. Maintaining functional independence and brain metastases control is thus increasingly important. Improved radiotherapy treatment techniques could provide better control and survival outcomes whilst maintain QoL and functional capacity.

Condition Brain Metastasis, Brain Metastases
Clinical Study IdentifierNCT04452084
SponsorNational Cancer Centre, Singapore
Last Modified on24 January 2021


Yes No Not Sure

Inclusion Criteria

-80 years old patients with radiological confirmed brain metastases (5-25 lesions)
Histologically proven malignancy of primary cancer
ECOG performance status 2
Maximum lesion or cavity size 5cm
For patients with large ( 3cm) lesions, a neurosurgical consult is recommended as the risk of cerebral oedema and hydrocephalus is higher with RT. A Ventricular-peritoneal shunt/ surgical excision may be required prior to planning of RT
If brain surgery or other invasive procedures are performed, the treatment can only begin at least 2-weeks post-procedure
Life expectancy of at least 6 months
Negative serum pregnancy test within 14 days prior to registration for women of childbearing potential
Women of childbearing potential and male participants who are sexually active must agree to use a medically effective means of birth control throughout protocol treatment
Not recommended or does not want Stereotactic Radiosurgery (SRS)
Agrees to be randomised to either HA-WBRT or HA-SIB-WBRT

Exclusion Criteria

Prior whole brain radiotherapy
Prior SRS is not an exclusion. Details of treatment must be recorded
Concurrent systemic cytotoxic treatment
If patient is on systemic treatment a treatment break of at least 7 days for immunotherapy or chemotherapy and 3 days for targeted therapy is required before and after radiotherapy
Leptomeningeal disease
Extensive extracranial disease, not controlled by systemic treatment
Severe, active co-morbidity, defined as follows
Major medical or psychiatric illness, which in the investigator's opinion would interfere with the completion of therapy and follow up or with full understanding of the risks and potential complications of the therapy
Unstable angina and/or uncontrolled congestive heart failure
Myocardial infarction within the last 6 months
Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration; note that patients switched from IV antibiotics and currently on oral antibiotics whose infection is assessed to be adequately treated or controlled are eligible
Chronic Obstructive Pulmonary Disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy within 30 days prior to registration
Acquired Immune Deficiency Syndrome (AIDS) based upon current CDC definition; note, however, that HIV testing is not required for entry into this protocol. The need to exclude patients with AIDS from this protocol is necessary because the treatments involved in this protocol may be significantly immunosuppressive
Dementia, ongoing psychotic episodes or moderate-severe depression (PHQ-9)
Recent stroke in the past 3 months
Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception
ECOG performance status >2 despite a duration of high dose steroids
Symptomatic brain metastases limiting ADLs
Rapid brain progression
Patients unable to give informed consent
Total tumour planning target volume (PTV) >60cc
Radiological evidence of hydrocephalus
Contraindication to Gadolinium contrast-enhanced MRI brain
Patients who are unable to meet expected follow-up schedule (e.g. non-resident patients)
Patients with diagnoses of small cell carcinoma, lymphoma or primary brain tumour
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