Study of Craniospinal Irradiation With Linac Based Volumetric Modulated Arc Therapy (VMAT) for Patients With Leptomeningeal Metastasis

N/ANot Yet RecruitingNCT06984523

NYU Langone Health20 enrolled

Overview

The purpose of this study is to confirm the safety and efficacy of linac based Volumetric Modulated Arc Therapy (VMAT) for craniospinal irradiation (CSI) in solid tumor cancer patients with leptomeningeal metastasis. The primary aim is to determine if linac based VMAT CSI for leptomeningeal metastasis improves central nervous system (CNS) progression free survival (PFS) compared to the historical standard control CNS PFS in patients treated with Involved Field Radiation Therapy (IFRT).

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Leptomeningeal Metastasis

Interventions

Varian Eclipse

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Solid tumor cancer primary with leptomeningeal metastases established radiographically and/or by CSF cytology 2. Candidate for radiation therapy for the treatment of leptomeningeal metastases 3. If patient had prior radiation, a treatment plan can be generated that will not exceed normal tissue tolerances 4. Patient must have reasonable systemic treatment options, as confirmed by their medical oncologist 5. Age ≥ 18 years old 6. Able to provide informed consent 7. Karnofsky Performance Scale (KPS) ≥ 60 8. Adequate hematologic baseline 1. Hemoglobin \> 8g/dL 2. Absolute neutrophil count \>1,000/mm3 3. Platelet count \> 100,000/mm3 9. Female subjects must either be of 1. Non-reproductive potential (over 60 years old, or without menses for at least 1 year without an alternative medical cause) 2. Have history of hysterectomy, bilateral tubal ligation, or bilateral oophorectomy 3. Must have negative serum/urine pregnancy test 4. If of reproductive age, must practice effective contraceptive method Exclusion Criteria: 1. Patient has multiple severe neurologic deficits per physician assessment 2. Patient has diffuse systemic disease without reasonable systemic therapy options 3. Patient is unable to undergo MRI brain and spine with gadolinium contrast 4. Prior radiation that would preclude development of a treatment plan that respects normal tissue constraints 5. Pregnant or lactating women 6. Prisoners

Outcomes

Primary Outcomes

Time to central nervous system (CNS) progression free survival

Time to CNS progression free survival will be estimated using Kaplan Meier methods for censored data that includes CNS progressions. CNS disease progression will be defined as new or worsening neurologic deficit unrelated to therapeutic intervention via neurological assessment using Neurologic Assessment in Neuro-Oncology (NANO) scale, cerebrospinal fluid (CSF) cytology being newly positive for malignancy after initially being negative, MRI brain with and without contrast or MRI total spine with and without contrast shows progression per the European Organization for Research and Treatment of Cancer (EORTC) Brain Tumor Group and the Response Assessment in Neuro-Oncology (RANO) scorecard.

Time frame: From baseline up to 1 year from end of treatment

Secondary Outcomes

Overall survival

Overall survival will be estimated using Kaplan Meier methods for censored data that includes deaths as events.

Time frame: From baseline up to 1 year from end of treatment

Time to CNS progression

Time to CNS progression will be analyzed using competing risk methods, considering death and progression from other causes as competing risks.

Time frame: From baseline up to 1 year from end of treatment

Rate of cessation of systemic therapy

Time frame: 1 year post-treatment

Number of treatment-related adverse events

Time frame: End of study (up to 2 years)

M.D. Anderson Symptom Inventory - Brain Tumor (MDASI-BT) score

The MDASI-BT includes 22 items assessing severity of brain tumor symptoms and 6 items assessing interference. Symptom severity and interference are assessed on a scale from 0-10 scale. A score of 0 indicates "not present" or "did not interfere," while a score of 10 represents "as bad as you can imagine" or "interfered completely". Scores range from 0-280. Higher scores indicate the brain tumor significantly impairs daily functioning.

Time frame: End of study (up to 2 years)

M. D. Anderson Symptom Inventory - Spine Tumor (MDASI-SP) score

The MDASI-SP includes 18 items assessing severity spinal tumor symptoms and 6 items assessing interference. Symptom severity and interference are assessed on a scale from 0-10 scale. A score of 0 indicates "not present" or "did not interfere," while a score of 10 represents "as bad as you can imagine" or "interfered completely". Scores range from 0-240. Higher scores indicate the brain tumor significantly impairs daily functioning.

Time frame: End of study (up to 2 years)

Functional Assessment of Cancer Therapy - Brain (FACT-Br) score

The FACT-Brain (FACT-Br) is one such instrument that assesses brain-tumor related QOL issues. The questionnaire consists of the FACT-G plus a brain-tumor specific scale. A total of 50 items are included that cover the following domains of QOL: physical well-being, social/family well-being, emotional well-being, functional well-being, and disease specific concerns. Patients are asked to indicate the presence/severity of certain issues/symptoms on a scale of 0 - 4 (a 5-point Likert Scale). Higher scores indicate decreased health-related quality of life.

Time frame: End of study (up to 2 years)

Study of Craniospinal Irradiation With Linac Based Volumetric Modulated Arc Therapy (VMAT) for Patients With Leptomeningeal Metastasis

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts