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Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT02179086
Other study ID # NRG-BN001
Secondary ID NCI-2014-01072NR
Status Active, not recruiting
Phase Phase 2
First received
Last updated
Start date October 27, 2014
Est. completion date May 2026

Study information

Verified date January 2024
Source NRG Oncology
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This randomized phase II trial studies how well dose-escalated photon intensity-modulated radiation therapy (IMRT) or proton beam radiation therapy works compared with standard-dose radiation therapy when given with temozolomide in patients with newly diagnosed glioblastoma. Radiation therapy uses high-energy x-rays and other types of radiation to kill tumor cells and shrink tumors. Specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. Drugs, such as temozolomide, may make tumor cells more sensitive to radiation therapy. It is not yet known whether dose-escalated photon IMRT or proton beam radiation therapy is more effective than standard-dose radiation therapy with temozolomide in treating glioblastoma.


Description:

PRIMARY OBJECTIVES: I. To determine if dose-escalated and -intensified photon IMRT or proton beam therapy (using a dose-per-fraction escalation with simultaneous integrated boost) with concomitant and adjuvant temozolomide improves overall survival, as compared to standard-dose photon irradiation with concomitant and adjuvant temozolomide. SECONDARY OBJECTIVES: I. To indirectly compare dose-escalated and -intensified photon IMRT to dose-escalated and -intensified proton beam therapy in terms of overall survival. II. To indirectly compare and record toxicities of dose-escalated and -intensified photon IMRT versus dose-escalated and -intensified proton beam therapy and directly compare the toxicities of these approaches versus standard-dose photon irradiation on the backbone of concomitant and adjuvant temozolomide. III. To determine if dose-escalated and -intensified photon IMRT or proton beam therapy (using a dose-per-fraction escalation with simultaneous integrated boost) with concomitant and adjuvant temozolomide improves perceived cognitive symptom severity, as compared to standard-dose photon irradiation with concomitant and adjuvant temozolomide. IV. To determine if dose-escalated and -intensified photon IMRT or proton beam therapy (using a dose-per-fraction escalation with simultaneous integrated boost) with concomitant and adjuvant temozolomide improves neurocognitive function, as compared to standard-dose photon irradiation with concomitant and adjuvant temozolomide. V. To indirectly determine if dose-escalated and -intensified proton beam therapy with concomitant and adjuvant temozolomide improves perceived cognitive symptom severity, as compared to dose-escalated and -intensified photon IMRT, and to directly compare symptom burden with these approaches versus standard-dose photon irradiation on the backbone of concomitant and adjuvant temozolomide. VI. To indirectly determine if dose-escalated and -intensified proton beam therapy with concomitant and adjuvant temozolomide improves neurocognitive function, as compared to dose-escalated and -intensified photon IMRT, and to directly compare neurocognitive function with these approaches versus standard-dose photon irradiation on the backbone of concomitant and adjuvant temozolomide. TERTIARY OBJECTIVES: I. Tissue banking for future translational science projects that will be determined based on the state of the science at the time the primary endpoint is reported and will be submitted to National Cancer Institute (NCI) for review and approval. II. To prospectively compare CD4 lymphopenia between dose-escalated and intensified proton beam therapy, dose-escalated and -intensified photon IMRT, and standard-dose photon irradiation and determine whether CD4 lymphopenia impacts overall survival. III. To explore the most appropriate and clinically relevant technological parameters to ensure quality and effectiveness throughout radiation therapy processes, including imaging, simulation, patient immobilization, target and critical structure definition, treatment planning, image guidance and delivery. - To establish feasibility and clinical relevancy of quality assurance guidelines. - To evaluate efficacy of quality assurance tools. IV. To explore the most appropriate and clinically relevant advanced and standard MRI imaging parameters. - To evaluate the feasibility of differentiating pseudo-progression and true progression in a multi institutional setting using MR diffusion and perfusion imaging. - To evaluate for early, imaging biomarkers of response and overall survival. OUTLINE: Patients are assigned to 1 of 2 groups depending on enrolling institution. Within each group, patients will be randomized 1:2 in favor of the experimental arms. GROUP I (PHOTON IMRT CENTERS): Patients are randomized to 1 of 2 treatment arms. ARM A1: Patients undergo standard-dose photon irradiation using 3-dimensional conformal radiation therapy (3D-CRT) or IMRT once daily (QD), 5 days a week for 23 fractions plus a boost of 7 additional fractions. ARM B: Patients undergo dose-escalated and -intensified photon IMRT QD, 5 days a week for a total of 30 fractions. GROUP II (PROTON CENTERS): Patients are randomized to 1 of 2 treatment arms. ARM A2: Patients undergo standard-dose photon irradiation using 3D-CRT or IMRT as in Arm A1. ARM C: Patients undergo dose-escalated and -intensified proton beam radiation therapy QD, 5 days a week for a total of 30 fractions. In all treatment arms, patients receive temozolomide orally (PO) QD on days 1-49 of radiation therapy. Beginning 4 weeks later, patients receive temozolomide PO QD on days 1-5. Treatment repeats every 28 days for up to 12 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 1 year, every 4 months for 1 year, and then every 6 months thereafter.


Other known NCT identifiers
  • NCT02163135

Recruitment information / eligibility

Status Active, not recruiting
Enrollment 624
Est. completion date May 2026
Est. primary completion date May 2024
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - PRIOR TO STEP 1 REGISTRATION - A diagnostic contrast-enhanced magnetic resonance imaging (MRI) (no other scan type allowed) of the brain must be performed postoperatively within 72 hours of resection; the enhancing tumor must have a maximal diameter of 5 cm; the tumor diameter will be the greatest diameter as measured on the contrast-enhanced postoperative MRI and will include residual disease and/or the postoperative surgical cavity as appropriate; for cases where residual disease or postoperative surgical cavity is NOT identifiable (e.g., polar glioblastomas [GBMs] where a polar lobectomy is performed), the patient will be excluded from the trial - The GBM tumor must be located in the supratentorial compartment only (any component involving the brain stem or cerebellum is not allowed) - Patients must provide study-specific informed consent prior to step 1 registration - PRIOR TO STEP 2 REGISTRATION - Histologically proven diagnosis of glioblastoma (World Health Organization [WHO] grade IV) confirmed by central review prior to step 2 registration - Tumor tissue that is determined by central pathology review prior to step 2 registration to be of sufficient quantity for analysis of O(6)-methylguanine-DNA-methyltransferase (MGMT) status - Patients must have at least 1 block of tumor tissue; submission of 2 blocks is strongly encouraged to maximize the chances of eligibility; at least 1 cubic centimeter of tissue composed primarily of tumor must be present - Diagnosis must be made by surgical excision, either partial or complete; stereotactic biopsy or cavitron ultrasonic suction aspirator (CUSA) technique are not allowed - History/physical examination within 28 days prior to step 2 registration - The patient must have recovered from effects of surgery, postoperative infection, and other complications within 28 days prior to step 2 registration - Documentation of steroid doses within 28 days prior to step 2 registration - Karnofsky performance status >= 70 within 28 days prior to step 2 registration - Age >= 18 - Absolute neutrophil count (ANC) >= 1,800 cells/mm^3 - Platelets >= 100,000 cells/mm^3 - Hemoglobin >= 10.0 g/dl (note: the use of transfusion or other intervention to achieve hemoglobin (Hgb) >= 10.0 g/dl is acceptable) - Bilirubin =< 1.5 upper limit of normal (ULN) - Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 x ULN - Negative serum pregnancy test obtained for females of child-bearing potential within 28 days prior to step 2 registration Exclusion Criteria: - 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) - Recurrent or multifocal malignant gliomas - Any site of distant disease (for example, drop metastases from the GBM tumor site) - Prior chemotherapy or radiosensitizers for cancers of the head and neck region; note that prior chemotherapy for a different cancer is allowable (except temozolomide) - Prior use of Gliadel wafers or any other intratumoral or intracavitary treatment are not permitted - Prior radiotherapy to the head or neck (except for T1 glottic cancer), resulting in overlap of radiation fields - Severe, active co-morbidity, defined as follows: - Unstable angina at step 2 registration - Transmural myocardial infarction within the last 6 months prior to step 2 registration - Evidence of recent myocardial infarction or ischemia by the findings of S-T elevations of >= 2 mm using the analysis of an electrocardiogram (EKG) performed within 28 days prior to step 2 registration - New York Heart Association grade II or greater congestive heart failure requiring hospitalization within 12 months prior to step 2 registration - Serious and inadequately controlled arrhythmia at step 2 registration - Serious or non-healing wound, ulcer or bone fracture or history of abdominal fistula, intra-abdominal abscess requiring major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to step 2 registration, with the exception of the craniotomy for surgical resection - Acute bacterial or fungal infection requiring intravenous antibiotics at the time of step 2 registration - Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; note, however, that laboratory tests for coagulation parameters are not required for entry into this protocol - Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of step 2 registration - Acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease Control and Prevention (CDC) definition; note, however, that human immunodeficiency virus (HIV) testing is not required for entry into this protocol - Any other severe immunocompromised condition - Active connective tissue disorders, such as lupus or scleroderma, that in the opinion of the treating physician may put the patient at high risk for radiation toxicity - End-stage renal disease (ie, on dialysis or dialysis has been recommended) - Any other major medical illnesses or psychiatric treatments that in the investigator's opinion will prevent administration or completion of protocol therapy - Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception - Patents treated on any other therapeutic clinical protocols within 30 days prior to step 2 registration - Inability to undergo MRI (e.g., due to safety reasons, such as presence of a pacemaker, or severe claustrophobia) - Postoperative tumor plus surgical bed size exceeds 5 cm in maximum diameter.

Study Design


Intervention

Radiation:
3-dimensional conformal radiation therapy
Undergo standard-dose 3D-CRT
intensity-modulated radiation therapy
Undergo standard-dose IMRT
photon beam radiation therapy
Undergo dose-escalated and -intensified photon IMRT
intensity-modulated radiation therapy
Undergo dose-escalated and -intensified photon IMRT
proton beam radiation therapy
Undergo dose-escalated and -intensified proton beam radiation therapy
Drug:
temozolomide
Given PO
Other:
laboratory biomarker analysis
Correlative studies

Locations

Country Name City State
Canada CHUM - Centre Hospitalier de l'Universite de Montreal Montreal Quebec
Canada CHUM - Hopital Notre-Dame Montreal Quebec
Canada McGill University Department of Oncology Montreal Quebec
Canada The Research Institute of the McGill University Health Centre (MUHC) Montreal Quebec
Canada Ottawa Hospital and Cancer Center-General Campus Ottawa Ontario
Canada CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ) Quebec City Quebec
Canada Saskatoon Cancer Centre Saskatoon Saskatchewan
Canada BCCA-Vancouver Island Cancer Centre Victoria British Columbia
Canada Windsor Regional Cancer Centre Windsor Ontario
United States Cleveland Clinic Akron General Akron Ohio
United States Saint Joseph Mercy Hospital Ann Arbor Michigan
United States University of Michigan Comprehensive Cancer Center Ann Arbor Michigan
United States Langlade Hospital and Cancer Center Antigo Wisconsin
United States Mission Hospital Asheville North Carolina
United States Emory Proton Therapy Center Atlanta Georgia
United States Emory University Hospital Midtown Atlanta Georgia
United States Emory University Hospital/Winship Cancer Institute Atlanta Georgia
United States Sutter Cancer Centers Radiation Oncology Services-Auburn Auburn California
United States Austin Cancer Centers-Central Austin Austin Texas
United States Austin Cancer Centers-North Austin Texas
United States Dell Seton Medical Center at The University of Texas Austin Texas
United States Texas Oncology - Central Austin Cancer Center Austin Texas
United States Texas Oncology - South Austin Cancer Center Austin Texas
United States Texas Oncology-Austin Midtown Austin Texas
United States AIS Cancer Center at San Joaquin Community Hospital Bakersfield California
United States Maryland Proton Treatment Center Baltimore Maryland
United States University of Maryland/Greenebaum Cancer Center Baltimore Maryland
United States Memorial Sloan Kettering Basking Ridge Basking Ridge New Jersey
United States McLaren Cancer Institute-Bay City Bay City Michigan
United States UHHS-Chagrin Highlands Medical Center Beachwood Ohio
United States UM Upper Chesapeake Medical Center Bel Air Maryland
United States Sanford Joe Lueken Cancer Center Bemidji Minnesota
United States Alta Bates Summit Medical Center-Herrick Campus Berkeley California
United States Central Vermont Medical Center/National Life Cancer Treatment Berlin Vermont
United States Saint Luke's University Hospital-Bethlehem Campus Bethlehem Pennsylvania
United States Billings Clinic Cancer Center Billings Montana
United States University of Alabama at Birmingham Cancer Center Birmingham Alabama
United States Sanford Bismarck Medical Center Bismarck North Dakota
United States Boca Raton Regional Hospital Boca Raton Florida
United States Prisma Health Cancer Institute - Spartanburg Boiling Springs South Carolina
United States Saint Alphonsus Cancer Care Center-Boise Boise Idaho
United States Boston Medical Center Boston Massachusetts
United States Massachusetts General Hospital Cancer Center Boston Massachusetts
United States Tufts Medical Center Boston Massachusetts
United States Montefiore Medical Center - Moses Campus Bronx New York
United States New York-Presbyterian/Brooklyn Methodist Hospital Brooklyn New York
United States University of Vermont Medical Center Burlington Vermont
United States Sutter Cancer Centers Radiation Oncology Services-Cameron Park Cameron Park California
United States Eden Hospital Medical Center Castro Valley California
United States Mercy Hospital Cedar Rapids Iowa
United States Geauga Hospital Chardon Ohio
United States Medical University of South Carolina Charleston South Carolina
United States John H Stroger Jr Hospital of Cook County Chicago Illinois
United States Northwestern University Chicago Illinois
United States Rush University Medical Center Chicago Illinois
United States University of Chicago Comprehensive Cancer Center Chicago Illinois
United States University of Cincinnati Cancer Center-UC Medical Center Cincinnati Ohio
United States Case Western Reserve University Cleveland Ohio
United States Cleveland Clinic Cancer Center/Fairview Hospital Cleveland Ohio
United States Cleveland Clinic Foundation Cleveland Ohio
United States UCHealth Memorial Hospital Central Colorado Springs Colorado
United States Central Maryland Radiation Oncology in Howard County Columbia Maryland
United States Ohio State University Comprehensive Cancer Center Columbus Ohio
United States Riverside Methodist Hospital Columbus Ohio
United States Memorial Sloan Kettering Commack Commack New York
United States UT Southwestern/Simmons Cancer Center-Dallas Dallas Texas
United States Mass General/North Shore Cancer Center Danvers Massachusetts
United States Beaumont Hospital - Dearborn Dearborn Michigan
United States Decatur Memorial Hospital Decatur Illinois
United States Northwestern Medicine Cancer Center Kishwaukee DeKalb Illinois
United States Texas Oncology - Denison Cancer Center Denison Texas
United States Iowa Methodist Medical Center Des Moines Iowa
United States Henry Ford Hospital Detroit Michigan
United States Saint Luke's Hospital of Duluth Duluth Minnesota
United States Northeast Radiation Oncology Center Dunmore Pennsylvania
United States Mercy Cancer Center-Elyria Elyria Ohio
United States Ephrata Cancer Center Ephrata Pennsylvania
United States Willamette Valley Cancer Center Eugene Oregon
United States Sanford Roger Maris Cancer Center Fargo North Dakota
United States McLaren Cancer Institute-Flint Flint Michigan
United States Texas Oncology-Flower Mound Flower Mound Texas
United States Poudre Valley Hospital Fort Collins Colorado
United States Parkview Hospital Randallia Fort Wayne Indiana
United States Parkview Regional Medical Center Fort Wayne Indiana
United States Radiation Oncology Associates PC Fort Wayne Indiana
United States Texas Oncology - Fort Worth Cancer Center Fort Worth Texas
United States Fresno Cancer Center Fresno California
United States University of Florida Health Science Center - Gainesville Gainesville Florida
United States University of Texas Medical Branch Galveston Texas
United States Northwestern Medicine Cancer Center Delnor Geneva Illinois
United States Adams Cancer Center Gettysburg Pennsylvania
United States UM Baltimore Washington Medical Center/Tate Cancer Center Glen Burnie Maryland
United States Spectrum Health at Butterworth Campus Grand Rapids Michigan
United States Trinity Health Grand Rapids Hospital Grand Rapids Michigan
United States Marin General Hospital Greenbrae California
United States Prisma Health Cancer Institute - Eastside Greenville South Carolina
United States Prisma Health Cancer Institute - Faris Greenville South Carolina
United States Self Regional Healthcare Greenwood South Carolina
United States Prisma Health Cancer Institute - Greer Greer South Carolina
United States Legacy Mount Hood Medical Center Gresham Oregon
United States UPMC Pinnacle Cancer Center/Community Osteopathic Campus Harrisburg Pennsylvania
United States Memorial Sloan Kettering Westchester Harrison New York
United States Hartford Hospital Hartford Connecticut
United States M D Anderson Cancer Center Houston Texas
United States Memorial Hermann Memorial City Medical Center Houston Texas
United States Cleveland Clinic Cancer Center Independence Independence Ohio
United States Community Cancer Center East Indianapolis Indiana
United States Community Cancer Center North Indianapolis Indiana
United States Community Cancer Center South Indianapolis Indiana
United States IU Health Methodist Hospital Indianapolis Indiana
United States University of Mississippi Medical Center Jackson Mississippi
United States Baptist MD Anderson Cancer Center Jacksonville Florida
United States Baptist Medical Center South Jacksonville Florida
United States University of Florida Health Science Center - Jacksonville Jacksonville Florida
United States West Michigan Cancer Center Kalamazoo Michigan
United States North Kansas City Hospital Kansas City Missouri
United States University of Kansas Cancer Center Kansas City Kansas
United States University of Kansas Cancer Center - North Kansas City Missouri
United States Tennessee Cancer Specialists-Dowell Springs Knoxville Tennessee
United States Gundersen Lutheran Medical Center La Crosse Wisconsin
United States Northwell Health/Center for Advanced Medicine Lake Success New York
United States McLaren Cancer Institute-Lapeer Region Lapeer Michigan
United States Comprehensive Cancer Centers of Nevada Las Vegas Nevada
United States UTMB Cancer Center at Victory Lakes League City Texas
United States Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center Lebanon New Hampshire
United States Sechler Family Cancer Center Lebanon Pennsylvania
United States University of Arkansas for Medical Sciences Little Rock Arkansas
United States Trinity Health Saint Mary Mercy Livonia Hospital Livonia Michigan
United States Logan Regional Hospital Logan Utah
United States Loma Linda University Medical Center Loma Linda California
United States Cedars Sinai Medical Center Los Angeles California
United States Los Angeles General Medical Center Los Angeles California
United States USC / Norris Comprehensive Cancer Center Los Angeles California
United States Norton Hospital Pavilion and Medical Campus Louisville Kentucky
United States Lowell General Hospital Lowell Massachusetts
United States Covenant Medical Center-Lakeside Lubbock Texas
United States University of Wisconsin Carbone Cancer Center Madison Wisconsin
United States Fremont - Rideout Cancer Center Marysville California
United States Hillcrest Hospital Cancer Center Mayfield Heights Ohio
United States Froedtert Menomonee Falls Hospital Menomonee Falls Wisconsin
United States UH Seidman Cancer Center at Lake Health Mentor Campus Mentor Ohio
United States Miami Cancer Institute Miami Florida
United States UH Seidman Cancer Center at Southwest General Hospital Middleburg Heights Ohio
United States Medical College of Wisconsin Milwaukee Wisconsin
United States Memorial Medical Center Modesto California
United States McLaren Cancer Institute-Macomb Mount Clemens Michigan
United States McLaren Cancer Institute-Central Michigan Mount Pleasant Michigan
United States IU Health Ball Memorial Hospital Muncie Indiana
United States Intermountain Medical Center Murray Utah
United States Rutgers Cancer Institute of New Jersey New Brunswick New Jersey
United States Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital New Brunswick New Jersey
United States UC Comprehensive Cancer Center at Silver Cross New Lenox Illinois
United States Ochsner Medical Center Jefferson New Orleans Louisiana
United States Laura and Isaac Perlmutter Cancer Center at NYU Langone New York New York
United States Memorial Sloan Kettering Cancer Center New York New York
United States NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center New York New York
United States Kaiser Permanente Oakland-Broadway Oakland California
United States McKay-Dee Hospital Center Ogden Utah
United States University of Oklahoma Health Sciences Center Oklahoma City Oklahoma
United States Saint Joseph Hospital - Orange Orange California
United States UC Irvine Health/Chao Family Comprehensive Cancer Center Orange California
United States University of Kansas Cancer Center-Overland Park Overland Park Kansas
United States McLaren Cancer Institute-Owosso Owosso Michigan
United States Palo Alto Medical Foundation Health Care Palo Alto California
United States Advocate Lutheran General Hospital Park Ridge Illinois
United States University Hospitals Parma Medical Center Parma Ohio
United States Capital Health Medical Center-Hopewell Pennington New Jersey
United States OSF Saint Francis Medical Center Peoria Illinois
United States McLaren Cancer Institute-Northern Michigan Petoskey Michigan
United States Jefferson Torresdale Hospital Philadelphia Pennsylvania
United States Thomas Jefferson University Hospital Philadelphia Pennsylvania
United States University of Pennsylvania/Abramson Cancer Center Philadelphia Pennsylvania
United States Mayo Clinic Hospital in Arizona Phoenix Arizona
United States Saint Joseph's Hospital and Medical Center Phoenix Arizona
United States Pomona Valley Hospital Medical Center Pomona California
United States Saint Joseph Mercy Oakland Pontiac Michigan
United States Legacy Good Samaritan Hospital and Medical Center Portland Oregon
United States Utah Valley Regional Medical Center Provo Utah
United States Kaiser Permanente-Rancho Cordova Cancer Center Rancho Cordova California
United States Renown Regional Medical Center Reno Nevada
United States Saint Mary's Regional Medical Center Reno Nevada
United States Virginia Commonwealth University/Massey Cancer Center Richmond Virginia
United States Mayo Clinic in Rochester Rochester Minnesota
United States Rohnert Park Cancer Center Rohnert Park California
United States Sutter Cancer Centers Radiation Oncology Services-Roseville Roseville California
United States The Permanente Medical Group-Roseville Radiation Oncology Roseville California
United States Texas Oncology - Round Rock Cancer Center Round Rock Texas
United States Texas Oncology-Seton Williamson Round Rock Texas
United States William Beaumont Hospital-Royal Oak Royal Oak Michigan
United States South Sacramento Cancer Center Sacramento California
United States Sutter Medical Center Sacramento Sacramento California
United States University of California Davis Comprehensive Cancer Center Sacramento California
United States Coborn Cancer Center at Saint Cloud Hospital Saint Cloud Minnesota
United States Saint George Regional Medical Center Saint George Utah
United States Norris Cotton Cancer Center-North Saint Johnsbury Vermont
United States Lakeland Medical Center Saint Joseph Saint Joseph Michigan
United States Washington University School of Medicine Saint Louis Missouri
United States Regions Hospital Saint Paul Minnesota
United States Huntsman Cancer Institute/University of Utah Salt Lake City Utah
United States University of Texas Health Science Center at San Antonio San Antonio Texas
United States California Pacific Medical Center-Pacific Campus San Francisco California
United States North Coast Cancer Care Sandusky Ohio
United States UH Seidman Cancer Center at Firelands Regional Medical Center Sandusky Ohio
United States Palo Alto Medical Foundation-Santa Cruz Santa Cruz California
United States Lewis Cancer and Research Pavilion at Saint Joseph's/Candler Savannah Georgia
United States Mayo Clinic in Arizona Scottsdale Arizona
United States FHCC at Northwest Hospital Seattle Washington
United States SCCA Proton Therapy Center Seattle Washington
United States University of Washington Medical Center - Montlake Seattle Washington
United States Prisma Health Cancer Institute - Seneca Seneca South Carolina
United States Willis-Knighton Medical and Cancer Center Shreveport Louisiana
United States Sanford USD Medical Center - Sioux Falls Sioux Falls South Dakota
United States ProCure Proton Therapy Center-Somerset Somerset New Jersey
United States Kaiser Permanente Cancer Treatment Center South San Francisco California
United States Memorial Medical Center Springfield Illinois
United States Cleveland Clinic Cancer Center Strongsville Strongsville Ohio
United States Texas Oncology Cancer Center Sugar Land Sugar Land Texas
United States Palo Alto Medical Foundation-Sunnyvale Sunnyvale California
United States Moffitt Cancer Center Tampa Florida
United States University of Toledo Toledo Ohio
United States William Beaumont Hospital - Troy Troy Michigan
United States Arizona Oncology Associates-West Orange Grove Tucson Arizona
United States Banner University Medical Center - Tucson Tucson Arizona
United States Tyler Cancer Center Tyler Texas
United States Sutter Cancer Centers Radiation Oncology Services-Vacaville Vacaville California
United States Compass Oncology Vancouver Vancouver Washington
United States Legacy Salmon Creek Hospital Vancouver Washington
United States Virtua Voorhees Voorhees New Jersey
United States John Muir Medical Center-Walnut Creek Walnut Creek California
United States Northwestern Medicine Cancer Center Warrenville Warrenville Illinois
United States UW Cancer Center at ProHealth Care Waukesha Wisconsin
United States Aspirus Regional Cancer Center Wausau Wisconsin
United States University of Cincinnati Cancer Center-West Chester West Chester Ohio
United States Reading Hospital West Reading Pennsylvania
United States UHHS-Westlake Medical Center Westlake Ohio
United States Wheeling Hospital/Schiffler Cancer Center Wheeling West Virginia
United States Novant Health Forsyth Medical Center Winston-Salem North Carolina
United States Wake Forest University Health Sciences Winston-Salem North Carolina
United States Cleveland Clinic Wooster Family Health and Surgery Center Wooster Ohio
United States WellSpan Health-York Cancer Center York Pennsylvania

Sponsors (3)

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

Countries where clinical trial is conducted

United States,  Canada, 

Outcome

Type Measure Description Time frame Safety issue
Primary Overall survival (OS) compared between dose-escalated and -intensified photon IMRT or proton beam therapy with concomitant and adjuvant temozolomide and the standard-dose photon irradiation with concomitant and adjuvant temozolomide OS rate will be estimated using the Kaplan-Meier method, and differences between treatment arms will be tested in a stratified log-rank test, consistent with the stratified randomization. The OS rates by MGMT, recursive partitioning analysis (RPA) class and other prognostic factors will be estimated by Kaplan-Meier methods and compared using the log-rank test. Multivariate analyses with the Cox proportional hazard model for OS will be performed to assess the treatment effect adjusting for patient-specific risk factors. Date of randomization to the date of death due to any cause, assessed up to 5 years
Secondary OS when compared between dose-escalated and -intensified photon IMRT to dose-escalated and -intensified proton beam therapy If the instrumental variable assumptions hold, OS rate will be estimated using the Kaplan-Meier method, and differences between treatment arms will be tested in the log-rank test. Date of randomization to the date of death, assessed up to 5 years
Secondary Progression-free survival (PFS) PFS rates will be estimated using the Kaplan-Meier method and comparisons between treatment arms will be made in the same manner as for OS. Date of randomization to the date of progression or death, assessed up to 5 years
Secondary Incidence of treatment-related toxicity, as measured by the Common Terminology Criteria for Adverse Events version 4 Differences in observed severities of toxicities (grade 3+) between groups will be estimated using an exact binomial distribution together with 95% confidence interval. The difference between the 2 groups will be tested using a chi square test. If the instrumental variable assumptions hold the experimental arms will also be compared. Up to 5 years
Secondary Change in perceived cognitive function, as measured by M.D. Anderson Symptom Inventory Brain Tumor The change from baseline to each follow-up time point for the perceived cognitive symptom severity score will each be compared using a t-test with alpha=0.05, or Wilcoxon test if the data is not normally distributed, between treatment arms within each group. If the instrumental variable assumptions hold and the perceived cognitive function is significantly different within both groups, a test will be performed to compare between the 2 experimental arms. Baseline to up to 60 weeks
Secondary Change in neurocognitive function, as measured by Hopkins' Verbal Learning Test-Revised, Trail Making Test Parts A and B, and Controlled Oral Word Association Test The change from baseline to each follow-up time point for the perceived Clinical Trial Battery (CTB) composite score will each be compared using a t-test with alpha=0.05, or Wilcoxon test if the data is not normally distributed, between treatment arms within each group. If the instrumental variable assumptions hold and the CTB composite score is significantly different within both groups, a test will be performed to compare between the 2 experimental arms. Baseline to up to 60 weeks
Secondary Change in CD4 lymphopenia count The change from baseline to the completion of radiation will be compared between the control and experimental arms in each group using a t-test. If the instrumental variable assumptions hold, then it will be compared between the experimental arms. A repeated measures analysis, using a mixed effects model, will be used to assess the change of CD4 lymphopenia across time. CD4 count at 2 months after beginning therapy (dichotomized at 200) was shown to be prognostic of OS. This will be assessed here based on the CD4 count at the completion of chemoradiation which matches best to 2-months. Baseline to up to 5 years
Secondary Use of magnetic resonance diffusion and perfusion imaging to differentiate between tumor progression and pseudo-progression Retrospective analysis will be performed to evaluate and refine the method and the threshold cut-off point determined from our previous single institute data set to determine progression using the first one-third of the patient data collected in this trial. If the initial analysis supports our preliminary results with sufficient high sensitivity and specificity, e.g., 80% specificity and 90% sensitivity or higher, results will be validated using the remaining two-thirds of the imaging data. Up to 5 years
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