This clinical trial evaluates the side effects and possible benefits of operating on brain tumors prior to the tumor coming back (recurrence). Understanding when surgery is most useful to patients with brain tumors is important. Some patients may undergo chemotherapy or radiation but still have visible tumor remaining after treatment. The purpose of this research is to compare outcomes of those who have surgery after chemotherapy or radiation, but prior to tumor recurrence, to those who have surgery at a different time, or no surgery at all.
PRIMARY OBJECTIVE: I. To evaluate the safety and feasibility of surgical resection for pre-recurrent brain tumors. SECONDARY OBJECTIVES: I. To determine whether there are differences in overall survival for patients who receive radiation therapy (RT) prior to surgery as compared to patients who receive RT after surgery or patients undergoing no further surgery. II. To determine for patients having pre-recurrent surgery whether there is a longer interval to local/regional progression, any central nervous system (CNS) progression or need for subsequent intracranial treatment compared to patients receiving post-operative RT, time to each will be separately documented. III. To determine for patients with pre-operative as compared to post-operative fractionated radiation for brain metastases (mets) whether there is a decreased rate of local recurrence. IV. To determine for patients with pre-operative as compared to post-operative fractionated radiation for brain mets whether there is a decreased rate of leptomeningeal disease. CORRELATIVE RESEARCH OBJECTIVES: I. To determine the genetic and molecular alterations occurring in radiated brain and radiated tumor tissue compared to nonradiated tissue specimens (subjects will be matched to Mayo Clinic Cancer Center Neuro-Oncology Program Registry for the study of Nervous System Tumors 12-003458). II. To investigate the relative sensitivity of radiated human CNS tumors to senolytic or other therapies in ex vivo assays targeting radiation-induced biology to promote synthetic lethality using cryopreserved or fresh tissue. III. To investigate the availability and utility of candidate biomarkers reflective of tumor burden and therapeutic susceptibility, from tissue, cerebrospinal fluid (CSF) and peripheral blood. IV. Patients self-reported outcomes may be obtained through the Neurosurgery Registry program. As available, these data may be referenced as a screening tool for any impact on quality of life (QOL) associated with trial participation as compared to matched controls. OUTLINE: Patients undergo surgery as indicated clinically when applicable. Patients also undergo magnetic resonance imaging (MRI) or computed tomography (CT) throughout the study and may optionally undergo tissue sample collection on study. After completion of surgery, patients are followed up at 3 and 6 months, and then every 6 months thereafter.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
40
Undergo surgery
Mayo Clinic in Rochester
Rochester, Minnesota, United States
Feasibility of surgical resection by short and long term outcomes
Feasibility will be evaluated by meeting enrollment criteria.
Time frame: Up to 5 years
Incidence of adverse events
Safety will be evaluated by recording adverse events utilizing proper reporting measures.
Time frame: Up to 5 years
Overall survival
Median time of survival along with 95% confidence interval will be estimated using the Kaplan-Meier method.
Time frame: Time from initial diagnosis to the date of death/or censored at the time of last known alive, assessed up to 5 years
Progression free survival
Median time of progress-free survival along with the 95% confidence interval will be estimated using the Kaplan Meier method.
Time frame: Time from initial diagnosis to the date progression is identified, assessed up to 5 years
Neurosurgical morbidity
Postoperative complications such as wound infection and neurologic deficits will be logged. Additional metrics including hospital stay and readmission rates will also be logged. Standard descriptive statistics will be used to summarize the outcomes.
Time frame: Up to completion of surgery
Time to subsequent treatment (i.e. chemotherapy/immunotherapy and/or radiation)
Median time to subsequent treatment along with the 95% confidence interval will be estimated using standard descriptive statistics.
Time frame: Time from surgical resection at Mayo Clinic until an adjuvant treatment is administered, assessed up to 5 years
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Rate of local recurrence
Will be logged as a categorical value and continuous data - endpoint is diagnosis of local recurrent disease. The presence and time to local recurrent disease will be logged and standard descriptive statistics will be used to summarize the outcomes.
Time frame: Up to 5 years
Rate of leptomeningeal disease
Will be logged as both a categorical value and continuous data - endpoint is diagnosis of leptomeningeal disease. The presence and time to occurrence of leptomeningeal disease will be logged and standard descriptive statistics will be used to summarize the outcomes.
Time frame: Up to 5 years