Neurocognitive Impact of Different Irradiation Modalities for Patients With Grade I-II Skull Base Meningioma: (CANCER-COG)

Centre Francois Baclesse

Status: Enrolling

Conditions: Radiation Toxicity; Meningioma

Treatments: Radiation: Normo-fractionated proton therapy brain irradiation; Other: Cognitive assessment by a trained neuropsychologis; Radiation: Hypo-fractionated stereotactic brain irradiation; Radiation: Normo-fractionated intensity-modulated brain irradiation with or without stereotactic positioning

Study type: Interventional

Funder types: Other

Identifiers

NCT06036706

2022-A02097-36

Details and patient eligibility

About

For the purpose of this research, investigator will constitute several cohorts of patients, treated either by intensity-modulated radiotherapy, stereotactic radiotherapy or proton-therapy. This will allow better understanding the cognitive and anatomical damages caused by new radiotherapy techniques and better understanding how ionising radiation (X-rays or protons) acts in the long term on brain tissue. Longitudinal follow-up will be multimodal, based on yearly multi-parametric brain MRI to assess morphological changes, in relation with dosimetric data as well as neuropsychological performances, health-related quality of life, anxiety and depression disorders, memory tasks, and socio-professional reintegration. This will notably make it possible to evaluate the relationship between dosimetric data, age at the time of treatment, region of the brain irradiated, type of radiation used, dose per fraction, neurocognitive and neuro-anatomical consequences. A Normal Tissue Control Probability (NTCP) model will be also developed. Overall, the results of this study should contribute to the improvement of treatment techniques, in particular by preserving as much as possible the significant cerebral zones (hippocampi, frontal lobe, sub-ventricular zones, etc.), and to the management of patients by proposing appropriate support measures. In the proton-therapy cohort, evaluations will make it possible to establish more precisely the place that this new irradiation strategy should occupy in the management of low grade meningioma. Importantly, investigator have planned to constitute a last cohort, with subjects free of any neurological disease, to make it easier the interpretation of cognitive performances over time among patients in the three brain radiation cohorts.

Enrollment: 108 estimated patients

Sex: All

Ages: 20 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Patients:

Inclusion Criteria:

• Benign meningioma (grade I), or atypical meningioma (grade II)
• Histologic proven of benign meningioma, atypical meningioma or unequivocal radiological diagnosis of skull base meningioma if biopsy is recused.
• Indication of irradiation validated by a multidisciplinary meeting
• Age >20 years and <65 years
• Expected overall survival >10 years
• Adjuvant or exclusive irradiation is allowed.
• Signed informed consent form
• WHO Performance status equal to 0 or 1
• Patient affiliated to the French social health insurance
• Patient whose neuropsychological abilities allow to follow the requirements of the protocol

Exclusion Criteria:

• Patient with mutation in a known predisposition gene (NF-2, SMARCE-1).
• Cerebrovascular pathology, presence of other tumors of the nervous system, congenital malformations of the nervous system, multiple sclerosis, Parkinson's disease, organic psychosis (other than dementia), or schizophrenia.
• Other localization than skull base meningioma
• Histology/radiological features rather different than grade I-II meningioma
• Histologic proven grade III meningioma
• Uncontrolled epilepsy
• Contraindication to MRI
• Patient with a history of brain irradiation.
• Patient with a history of cancer in the last five years (excluding skin baso-cellular carcinoma)
• Pregnant/breastfeeding woman
• Any geographical conditions, social and associated psychopathology that may compromise the patient's ability to participate in the study
• Participation in a therapeutic trial evaluating a radiotherapy schedule or a new drug or combination for less than 30 days
• Patient deprived of freedom or under guardianship
• Hypersensibility to Gadolinium

Participants free of brain disease or cancer history:

Inclusion Criteria:

• Subject without any history of neurological disease (cerebral stroke, epilepsy, Intra cranial Neurosurgery procedure, meningioma, pituitary adenoma, Parkinson disease,Dementia...) or absence of personality disorders and progressive psychiatric pathology
• Age >20 years and <65 years
• Signed informed consent form
• WHO Performance status equal to 0 or 1
• Subject affiliated to the French social health insurance
• Subject whose neuropsychological abilities allow to follow the requirements of the protocol
• No major cognitive disorder that may compromise the realization of cognitive evaluations, defined as a MoCA score in accordance with the threshold depending on age and educational level according to the GRECOGVASC normative data

Non-inclusion criteria

• Cerebrovascular pathology, presence of other tumors of the nervous system, congenital malformations of the nervous system, multiple sclerosis, Parkinson's disease, organic psychosis (other than dementia), or schizophrenia
• History of epilepsy with antiepileptic drug
• Subject with a history of brain irradiation
• Subject with a history of cancer in the last five years (Excluding skin baso-cellular carcinoma)
• Pregnant/breastfeeding woman
• Any geographical conditions, social and associated psychopathology that may compromise the subject's ability to participate in the study
• Participation in a therapeutic trial - Subject deprived of freedom or under guardianship

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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108 participants in 4 patient groups

Cohort "IMRT":

Other group

Description:

Patients receiving normo-fractionated intensity-modulated brain irradiation with or without stereotactic positioning (IMRT, VMAT, Tomotherapy...)

Treatment:

Radiation: Normo-fractionated intensity-modulated brain irradiation with or without stereotactic positioning

Cohort "SRT"

Other group

Description:

Patients receiving hypo-fractionated stereotactic brain irradiation

Treatment:

Radiation: Hypo-fractionated stereotactic brain irradiation

Cohort "PRT"

Other group

Description:

Patients receiving normo-fractionated proton therapy brain irradiation

Treatment:

Radiation: Normo-fractionated proton therapy brain irradiation

Control cohort

Other group

Description:

Participants without any meningioma, cancer history or neurological comorbidities

Treatment:

Other: Cognitive assessment by a trained neuropsychologis