Using targeted radiation therapy before or after surgery for brain tumors

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This phase III trial investigates the effectiveness and side effects of stereotactic radiosurgery (SRS) in patients with metastatic brain tumors, comparing outcomes based on whether SRS is administered before or after surgical intervention. The primary objective is to assess the time to adverse outcomes such as local recurrence or symptomatic radiation brain necrosis. Secondary objectives include evaluating overall survival rates, patient-reported quality of life, surgical complications, and the timing of subsequent therapies. The study involves various interventions including surgery, imaging, and questionnaires to gather comprehensive data on patient outcomes.

Why it matters

Who can join: the full rules

Inclusion Criteria:

* Age \>= 18 years
* Histological or cytological confirmation of solid tumor malignancy and/or clinical history of known or suspected metastatic disease with an intraparenchymal brain tumor consistent with brain metastasis based on clinical and radiologic findings
* Clinical indication for surgical resection of one brain metastasis based on neurosurgery recommendation and patient deemed a surgical candidate
* Clinical indication and plan for stereotactic radiosurgery to all known brain lesions requiring treatment (=\< 10 metastases)
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) =\< 2
* Provide written informed consent or have a legally authorized representative who is responsible for the care and well-being of the potential study participant, provide consent
* Willing to continue follow-up visits, either at the enrolling institution or with a local medical doctor as clinically appropriate, and according to the study timeline. Clinical notes and digital copies of imaging must be provided to the enrolling site if follow-up is done externally

Exclusion Criteria:

* Any of the following:

  * Pregnant women
  * Nursing women
  * Men or women of childbearing potential who are unwilling to employ adequate contraception
* Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
* Immunocompromised patients and patients known to be human immunodeficiency virus (HIV) positive and currently receiving antiretroviral therapy. \* NOTE: Patients known to be HIV, but without clinical evidence of an immunocompromised state, are eligible for this trial
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
* Prior open neurosurgery for malignancy
* Known or clinically suspected primary germ cell tumor, small cell carcinoma, or lymphoma
* History of whole brain radiation therapy (WBRT)
* Known allergy to gadolinium, pacemaker, or other contraindication such as metal implant that is not safe for MRI. Patients with MRI-compatible implants including MRI compatible pacemakers are eligible
* Leptomeningeal metastasis/disease
* A brain metastasis that is located =\< 5 mm of the optic chiasm
* Any brain metastasis \> 5 cm in size
* \> 10 brain metastases
* Indication for surgical resection of \>= 2 brain metastases
* Indication for long-term (anticipated greater than 4 weeks) 4 mg dexamethasone equivalent of steroids or bevacizumab
* Actively enrolled on another brain metastases trial that is assessing the efficacy of either radiation or surgical interventions

Where it's running

• Mayo Clinic in Arizona
  Scottsdale, Arizona, United States Recruiting
• Mayo Clinic in Florida
  Jacksonville, Florida, United States Recruiting
• NIH Clinical Center
  Bethesda, Maryland, United States Recruiting
• Mayo Clinic in Rochester
  Rochester, Minnesota, United States Recruiting

Study contacts

• Principal investigator: Elizabeth Yan, M.D. — Mayo Clinic
• Study coordinator: Clinical Trials Referral Office
• Email: mayocliniccancerstudies@mayo.edu
• Phone: 855-776-0015

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.