A Double-Blind Phase II Randomized Study of Adaptively Delivered LINAC-Based Stereotactic Radiation for Volatile Brain Metastases With Same-Day Planning and Margin Reduction
The goal of this study is to evaluate the feasibility and effectiveness of same-day radiation planning and treatment. The study will shorten the time interval between radiation planning (radiation mapping) and radiation treatment. The intent of this shorter time interval is to increase the likelihood that the brain metastases being treated remain fully within the high-dose radiation fields. Participants will be randomized to receive brain-directed stereotactic radiation with a 1mm margin or 0mm margin, have their simulation/radiation planning imaging on the same day that brain-directed stereotactic radiation is delivered, and have repeat simulation/radiation planning scans during the course of treatment if more than 2-3 days have elapsed since the most recent scans.
• Participants must have a biopsy proven solid malignancy with at least one intact, residual or recurrent, intracranial lesion radiographically consistent with or pathologically proven to be a brain metastasis meeting one of the following criteria:
‣ Growth of 1.0mm per week or more, on average, based on the two most recent brain MRIs preceding study enrollment
⁃ Abutment, to within 1.0cm, of a region of intracranial edema
⁃ Proximity (within 5.0cm) to a surgical cavity created within 30 days of enrollment
⁃ Proximity (within 5.0cm) to another source of physical displacement
• Age of at least 18 years
• Karnofsky performance status of at least 60
• Estimated survival of at least 3-6 months in the opinion of the enrolling clinician and/or study PI
• Ability to understand and the willingness to sign a written informed consent document by either ink on paper or a DF/HCC approved eConsent medium