At a glance
ClinicalIndex Comparison Record- ✓Histologically-confirmed solid tumor with >5 sites of metastatic disease on imaging
- ✓High-risk bone metastases that are asymptomatic or minimally symptomatic (not requiring opioids)
- ✓Bulkiest sites of spinal osseous disease ≥2 cm
- ✓Disease at junctional levels including thoracic apex (Occiput to C2, C7-T1, T12-L2, L5-S1)
- ✕Previous RT to intended treatment site precluding acceptable treatment plan
- ✕Serious medical co-morbidities precluding RT
- ✕Pregnant or lactating women
- ✕Target lesion complicated by spinal cord compression or impending pathological fracture
Standardized by ClinicalIndex from the ClinicalTrials.gov record · verify against the source.
Prophylactic Radiotherapy of MInimally Symptomatic Spinal Disease (PROMISSeD Trial)
In Brief
A Phase 2 clinical trial evaluating Prophylactic Radiotherapy and Standard of care systemic therapy for Spine Metastases. Currently recruiting, targeting 74 participants across 1 site.
Detailed Summary
Early palliative care has been shown to improve the quality of life and even survival for patients with metastatic cancer. More and more supportive oncology teams in cancer centers now advocate for early integration of radiation therapy (RT) in a patient's palliative management course. While multiple randomized studies have evaluated the efficacy of different RT regimens in the treatment of symptomatic bone lesions, few studies have examined the impact of early, upfront RT for asymptomatic or minimally symptomatic (non- opioid dependent) spine metastases and its efficacy in preventing skeletal-related events (SREs). Since the pathophysiology of spinal metastatic disease is distinct from other bony metastatic disease, the proposed trial seeks to understand whether it is beneficial to patients with minimally symptomatic disease to undergo upfront RT to reduce the risks of SREs and their sequelae, including hospitalizations.
Study Details
Timeline
Interventions
Radiation therapy will be delivered according to department standards. For this protocol, total dose and dose fractionation may be delivered at the discretion of the treating radiation oncologist according to department standards. All techniques including conventional, three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and stereotactic radiosurgery/stereotactic body radiation therapy (SRS/SBRT) techniques may be used. Image guidance at the time of treatment delivery to verify patient positioning may be chosen at the discretion of the treating radiation oncologist according to department standards.
Standard of care systemic therapy, including chemotherapeutics, targeted therapies, immunomodulatory agents, and hormonal therapies will be delivered at the discretion of the treating medical oncologist. Patients may receive systemic therapy concurrently and there are no restrictions on initiation of systemic agents after radiotherapy including immunotherapy and hormonal therapy, the timing of which will be determined by a consensus between the treating medical and radiation oncologists.