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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT01417507
Other study ID # RTOG 0925
Secondary ID NCI-2011-02982CD
Status Completed
Phase N/A
First received August 13, 2011
Last updated March 17, 2015
Start date October 2011
Est. completion date December 2014

Study information

Verified date March 2015
Source Radiation Therapy Oncology Group
Contact n/a
Is FDA regulated No
Health authority United States: Institutional Review Board
Study type Observational

Clinical Trial Summary

This trial studies the natural history of brain function, quality of life, and seizure control in patients with brain tumor who have undergone surgery. Learning about brain function, quality of life, and seizure control in patients with brain tumor who have undergone surgery may help doctors learn more about the disease and find better methods of treatment and on-going care.


Description:

PRIMARY OBJECTIVES:

I. To determine if there is difference in the average changes of neurocognitive function (NCF) scores from baseline to the time of radiologic tumor progression or up to 5 years (whichever occurs first), between radiologically progressed and non-progressed patients.

SECONDARY OBJECTIVES:

I. To determine if there is difference in the time to neurocognitive decline, as defined by the Reliable Change Index - Within subjects Standard Deviation (RCI-WSD), between radiologically progressed and non-progressed patients.

II. To evaluate NCF during the postoperative observational period of progression-free survival (PFS) and after radiological progression for a total time on study of 5 years.

III. To determine if the changes in cognitive functioning are an early warning biomarker for radiological progression.

IV. To explore the effect of salvage therapy on cognitive outcomes in patients who progress during the study period for up to 5 years.

V. To evaluate quality-of-life (QOL) as measured by the European Organization for Research and Treatment of Cancer (EORTC) QOL-30 and QOL brain module (BCN20) and health utilities as measured by the European Quality of Life-5 Dimensions (EQ-5D), for a total time on study of 5 years.

VI. To evaluate seizure control for a total time on study of 5 years. VII. To evaluate molecular correlates of QOL, NCF, seizure control, and PFS. VIII. To characterize aberrant molecular pathways in low-grade gliomas (LGGs) and test the hypothesis that activation of signaling pathways will predict worse PFS and overall survival (OS).

IX. To explore the relationship between change in cognitive function and symptomatic progression (defined as worsening seizures or new or progressive neurologic deficits) or clinical progression (defined as initiation of treatment interventions such as radiotherapy, chemotherapy, or additional surgery).

OUTLINE:

Patients undergo neurocognitive assessment using the CogState Test battery (the Detection Test (DET), the Identification Test (IDN), the One Card Learning Test (OCLT), and the Groton Maze Learning Test (GMLT)) at baseline* and at 12, 24, 36, 42, 48, 54, and 60 months. Patients also complete the EORTC Quality of Life Questionnaire-Core 30 (QOL-30), the Brain Cancer Module-20 (BCM20), and the European Quality of Life-5 Dimensions (EQ-5D) questionnaires at baseline*, at 12, 24, 36, 48, and 60 months afterwards, and before undergoing any further treatment. Patients are instructed to complete a seizure and medication diary during study.

Patients undergo MRI scans at baseline*, at 12, 24, 36, 48, and 60 months, and at the time of radiological, clinical, or neurological failure.

NOTE: * 12 weeks after surgery.


Recruitment information / eligibility

Status Completed
Enrollment 82
Est. completion date December 2014
Est. primary completion date December 2014
Accepts healthy volunteers No
Gender Both
Age group 18 Years and older
Eligibility Inclusion Criteria:

- Central pathology confirmed diagnosis of supratentorial grade II oligodendroglioma, astrocytoma, or mixed oligoastrocytoma prior to step 2 registration

- No multifocal disease, based upon the following minimum diagnostic work-up:

- History/physical examination, including neurologic examination, within 84 days prior to step 2 registration

- Brain MRI with and without contrast within 84 days prior to Step 2 registration (Note: MRI 70 days after surgery is preferred and highly encouraged)

- The patient must be within one of the following categories:

- Maximal safe resection with minimal residual disease defined as follows:

- Removal of T2/fluid-attenuated inversion recovery (FLAIR) abnormalities thought to be primarily tumor, with a residual = 2 cm maximal tumor diameter/T2 FLAIR abnormality on MRI to be done within 84 days post-operatively

- If there is > 2 cm post-operative residual T2/FLAIR abnormality and the neurosurgeon believes this represents edema and not primarily tumor, the neurosurgeon is encouraged to repeat imaging within the allowed study period (up to 84 days post-operatively) to confirm resolution of edema

- MRI at the time of enrollment must document a = 2 cm residual maximal tumor diameter/T2 FLAIR abnormality

- Patients who required a second surgery to obtain a maximal safe resection will be eligible if the second surgery is performed within 84 days of the initial diagnostic procedure

- Age < 40 (any extent of resection)

- Age < 50 and preoperative tumor diameter < 4 cm (any extent of resection)

- Karnofsky performance status = 80%

- No prior invasive malignancy (except non-melanomatous skin cancer) unless disease-free for a minimum of 3 years (For example, carcinoma in situ of the breast, oral cavity, or cervix are all permissible)

- Must be able to undergo MRI of the brain with gadolinium

- No plans for adjuvant radiotherapy or chemotherapy after surgery

- No more than 84 days (12 weeks) since prior surgery

- No brain tumor recurrence

- No prior brain tumor surgery, radiation therapy and/or chemotherapy

Study Design

Observational Model: Cohort, Time Perspective: Prospective


Intervention

Procedure:
cognitive assessment
Undergo neurocognitive assessment
magnetic resonance imaging
Undergo MRI
Other:
laboratory biomarker analysis
Correlative studies
questionnaire administration
Ancillary studies
Procedure:
quality-of-life assessment
Ancillary studies

Locations

Country Name City State
Canada London Regional Cancer Program London Ontario
Canada McGill University Department of Oncology Montreal Quebec
United States Piedmont Hospital Atlanta Georgia
United States Billings Clinic Billings Montana
United States The Kirklin Clinic at Acton Road Birmingham Alabama
United States University of Alabama at Birmingham Birmingham Alabama
United States Montefiore Medical Center Bronx New York
United States Carolinas Medical Center Charlotte North Carolina
United States University of Cincinnati Cincinnati Ohio
United States Geisinger Medical Center Danville Pennsylvania
United States Evanston CCOP-NorthShore University HealthSystem Evanston Illinois
United States Leeward Radiation Oncology Center Ewa Beach Hawaii
United States Adams Cancer Center Gettysburg Pennsylvania
United States Saint Mary's Hospital Green Bay Wisconsin
United States Saint Vincent Hospital Green Bay Wisconsin
United States Cherry Tree Cancer Center Hanover Pennsylvania
United States Penn State Milton S Hershey Medical Center Hershey Pennsylvania
United States Hawaii Medical Center East Honolulu Hawaii
United States Queen's Medical Center Honolulu Hawaii
United States University of Hawaii Honolulu Hawaii
United States Norton Health Care Pavilion - Downtown Louisville Kentucky
United States Norton Suburban Hospital Louisville Kentucky
United States Community Memorial Hospital Menomonee Falls Wisconsin
United States Froedtert and the Medical College of Wisconsin Milwaukee Wisconsin
United States Providence Hospital Mobile Alabama
United States Christiana Care Health System-Christiana Hospital Newark Delaware
United States University of Oklahoma Health Sciences Center Oklahoma City Oklahoma
United States The Nebraska Medical Center Omaha Nebraska
United States Florida Hospital Orlando Florida
United States Radiation Therapy Oncology Group Philadelphia Pennsylvania
United States Arizona Oncology Services Foundation Phoenix Arizona
United States Arizona Oncology-Deer Valley Center Phoenix Arizona
United States Mayo Clinic Rochester Minnesota
United States University of Rochester Rochester New York
United States Barnes West County Hospital Saint Louis Missouri
United States Washington University School of Medicine Saint Louis Missouri
United States Huntsman Cancer Institute/University of Utah Salt Lake City Utah
United States Mayo Clinic in Arizona Scottsdale Arizona
United States Covenant Medical Center Waterloo Iowa
United States Waukesha Memorial Hospital Waukesha Wisconsin
United States York Hospital York Pennsylvania

Sponsors (3)

Lead Sponsor Collaborator
Radiation Therapy Oncology Group National Cancer Institute (NCI), NRG Oncology

Countries where clinical trial is conducted

United States,  Canada, 

Outcome

Type Measure Description Time frame Safety issue
Primary NCF as measured by each of the 4 neurocognitive tests (DET, IDN, OCLT, GMLT) Each of the battery's tests will be evaluated using the 2-sample t-test with a 2-sided significance level of 0.05 to determine if there is a clinically meaningful difference in the average change of NCF score from baseline to the time of radiologic tumor progression or up to 5 years (whichever occurs first) between radiologically progressed and non-progressed patients. In order to adjust for multiple comparisons and maintain the overall type I error of 0.05, Hochberg's procedure will be applied. Up to 5 years No
Secondary Time to neurocognitive decline in patients who progress and who do not progress radiologically, as defined by the RCI-WSD The cumulative incidence approach will be used to estimate the median time to neurocognitive impairment to account for the competing risk of death and to determine if there is a clinically meaningful difference in the time to neurocognitive decline, as defined by the RCI-WSD (reliable change index—within-subjects standard deviation), between radiologically progressed and non-progressed patients. Up to 5 years No
Secondary PFS Estimated using the Kaplan-Meier method, and difference between the activation of different signaling pathways will be tested using the log rank test. Multivariate analyses with the Cox proportional hazards model for PFS will be performed to assess the activation of the signaling pathway effect adjusting for patient-specific risk factors. The covariates to be evaluated for the multivariate models are: activation of signaling pathway status, age, tumor size, and other prognostic factors. The interval from registration to progression or death, whichever occurs first, assessed up to 5 years No
Secondary Radiological progression To determine if the NCF decline is an earlier warning biomarker to radiologic progression, we will use NCF change as a time-dependent covariate in a Cox proportional hazards (PH) regression model with radiological progression as the endpoint. The Cox model estimates the ratio of hazard rate of radiographic failure with and without neurocognitive decline. Anticonvulsant use, tumor size, tumor histology, and further treatment received if recurrence is discovered, which may also have impact on the radiological progression, will also be considered in this Cox PH regression analysis. Up to 5 years No
Secondary Effect of salvage therapy on cognitive outcomes in patients who progress Up to 5 years No
Secondary QOL as measured by the EORTC QOL-30, EORTC QOL-BCN20, and EQ-5D The general linear mixed-effects model will be used to evaluate the changes of QOL and health utilities over time. Up to 5 years No
Secondary Frequency of seizures, evaluated using patient seizure diary Marginal models will be used to evaluate the change of frequencies of seizures over time for up to 5 years. Anticonvulsant use, tumor size, tumor histology, further treatment received if recurrence is discovered, and other prognostic factors will also be included in the covariates sets. The available molecular marker information will also be included as a covariate to evaluate the molecular correlates of seizure frequency. Up to 5 years No
Secondary Molecular correlates of QOL, NCF, seizure control, and PFS Up to 5 years No
Secondary OS Estimated using the Kaplan-Meier method, and difference between the activation of different signaling pathways will be tested using the log rank test. Multivariate analyses with the Cox proportional hazards model for OS will be performed to assess the activation of the signaling pathway effect adjusting for patient-specific risk factors. The covariates to be evaluated for the multivariate models are: activation of signaling pathway status, age, tumor size, and other prognostic factors. Up to 5 years No
Secondary Symptomatic or clinical progression Symptomatic and clinical progression will be explored for the correlation with cognitive changes in addition to radiological progression. Up to 5 years No
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