Neoadjuvant Radio-chemotherapy Safety Pilot Study in Patients With Glioblastoma
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: hypofractionated stereotactic radiotherapy, Stereotactic biopsy, resection, Chemotherapy.
- Who it may be relevant to
- Registry conditions: Glioblastoma, Glioblastoma Multiforme, Glioblastoma, IDH-wildtype, Radiotherapy; Complications. Basic parameters: 18 years — 75 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Spain
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
The goal of this clinical trial is to evaluate the safety and efficacy of neoadjuvant radiochemotherapy in the surgical resection of glioblastoma (GBM). The main questions it aims to answer are: * What is the safety profile of neoadjuvant radiochemotherapy in terms of neurological deficit, radionecrosis, edema, headache, wound dehiscence, infection, and cerebrospinal fluid fistula? * What is the efficacy of neoadjuvant radiochemotherapy in terms of progression-free survival, overall survival, cognitive function, and quality of life? Participants will undergo the following tasks and treatments: * Stereotactic biopsy and diagnosis confirmation. * Conformal hypofractionated stereotactic radiotherapy with concurrent temozolomide. * Supramarginal resection guided by 5-ALA under intraoperative neurophysiological monitoring. * Maintenance temozolomide administration for 6 months. Researchers will compare the group receiving neoadjuvant radiochemotherapy to the control group following the standard Stupp protocol to assess safety and efficacy outcomes.
Detailed description
Objectives: To study the safety (primary) and efficacy (secondary) of neoadjuvant radiochemotherapy in the surgical resection of glioblastoma (GBM). Safety measures include: neurological deficit, radionecrosis (radiological and clinical), edema, headache, wound dehiscence, infection, and cerebrospinal fluid fistula. Efficacy measures include progression-free survival (PFS), overall survival (OS), cognitive function (MoCA Scale), and quality of life (EuroQol scales, EORTC QLQ-HN35, FACT-Br, and TWiST). Methods: Pilot safety and efficacy study in 6 patients compared to 6 controls. 2-year follow-up. A data safety monitoring committee will review the data one month after surgery for each of the first three patients to decide whether to stop or continue the study. Stereotactic biopsy will be performed, and if GBM is diagnosed, patients will undergo conformal hypofractionated stereotactic radiotherapy to the FLAIR hyperintense signal including the contrast-enhancing tumor on T1, with a total dose of 3990 cGy at the margin in 15 fractions of 266 cGy and concurrent temozolomide (TMZ). 5 weeks later, patients will undergo supramarginal resection guided by 5-ALA under intraoperative neurophysiological monitoring. 7 days after surgery, maintenance TMZ will be administered for 6 months. The control group will follow standard treatment (Stupp protocol). Data analysis will be performed using non-parametric tests. Samples from successive surgeries will be studied with histology, molecular biology, and cell cultures.
Interventions
- Radiation hypofractionated stereotactic radiotherapy
conformal hypofractionated stereotactic radiotherapy to the FLAIR hyperintense signal, including the contrast-enhancing tumor on T1, with a total dose of 3990 cGy at the margin in 15 fractions of 266 cGy, one session per day, five days a week, and concurrent temozolomide (TMZ) at 75 mg/m2/day for 7 days/week during the irradiation period - Procedure Stereotactic biopsy
Stereotactic biopsy - Procedure resection
supramarginal resection guided by 5-ALA under intraoperative neurophysiological monitoring - Drug Chemotherapy
4 weeks post-surgery, temozolomide (TMZ) will be administered for 6 months - Radiation radiotherapy Stupp protocol
radiotherapy + TMZ concurrently after 4 weeks of resection surgery, as per usual protocol: Three-dimensional radiotherapy planning to deliver a total dose of 60 Gy, with a fractionation of 2 Gy/day, 5 days/week, encompassing a 1-2 cm margin around the contrast-enhancing region defined on T1 imaging or the entire abnormal volume defined on T2 or FLAIR imaging (Li et al., 2016) + TMZ at 75 mg/m2/day for 7 days/week, for 6 weeks during radiotherapy. - Drug Chemotherapy Stupp Protocol
temozolomide (TMZ) will be administered for 6 months according to the Stupp protocol.
Primary outcome measures
- Emergent Adverse Events assessed by physical and neurological examination [Time frame: Clinical follow-up every month for 2 years]
- Emergent Adverse Events assessed by evaluation of the results of the analysis with hematology and biochemistry. [Time frame: Clinical follow-up every month for 2 years]
- Emergent Adverse Events assessed by brain RM image [Time frame: every 3 months after surgery, for 2 years]
- Emergent Adverse Events assessed by AC_PET with 18-FdG [Time frame: every 6 months after surgery, for 2 years]
Secondary outcome measures (4)
- Efficacy assessed by progression-free survival (PFS) [Time frame: through study completion, an average of 2 yeas.]
- Efficacy assessed by overall survival (OS) [Time frame: through study completion, an average of 2 yeas.]
- Quality of life assessed by The Functional Assessment of Cancer Therapy-Brain (FACT-Br) [Time frame: every 3 months after surgery, for 2 years]
- Cognitive functionality assessed by MONTREAL COGNITIVE ASSESSMENT (MOCA) [Time frame: every 3 months after surgery, for 2 years]
Eligibility criteria
Inclusion criteria
- Age between 18 and 75 years.
- Unifocal disease.
- Unilobar tumor.
- Clinical-radiological diagnosis of supratentorial unicentric high-grade glioma, eligible for macroscopically complete resection.
Exclusion criteria
- Multilobar tumor, interhemispheric or infratentorial extension, or multifocal disease.
- Midline shift greater than 1 cm.
- Intracranial hypertension symptoms requiring corticosteroid treatment.
- Synchronous neoplasia.
- Any contraindication for surgery, radiotherapy, or TMZ treatment.
- Cognitive impairment.
- Rejection of informed consent.
- Inability to follow up for 2 years.
- Women of childbearing potential according to the Clinical Trial Facilitation Group (CTFG) criteria. (https://www.hma.eu/fileadmin/dateien/Human\_Medicines/01-About\_HMA/Working\_Groups/CTFG/2020\_09\_HMA\_CTFG\_Contraception\_guidance\_Version\_1.1.pdf)
- Hypersensitivity to the active ingredient or any excipients of the investigational drug.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Open label
- Primary purpose
- Treatment
Study locations
Spain · 1 center
- Hospital Clínico San Carlos — Madrid
Identifiers
NCT: NCT06418113 · 22/399