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Impact of iMRI on the Extent of Resection in Patients With Newly Diagnosed Glioblastomas

Study Purpose

Standard treatment of glioblastomas (GBMs) consists of microsurgical resection followed by concomitant chemoradiation. The extent of resection is one of the most important prognostic factors with significant influence on the survival of patients. State of the art technique to achieve the most radical resection possible in conventional surgery is fluorescence-guidance with 5-aminolevulinic acid (5-ALA). If available, intraoperative MRI (iMRI)-guided tumor resection enables an intraoperative resection control and subsequent continuation of surgery if contrast enhancing tumor remnants are found. Therefore a more radical resection and longer survival of patients might be possible. To date no comparison of these two leading technologies for GBM-surgery is available to identify the best surgical therapy of this fatal disease and to justify significant healthcare-economic differences between both technologies. Goal of this study is to assess the value of iMRI guidance in the resection of GBMs in comparison to conventional 5-ALA microsurgery. Primary endpoint is the number of total resections (no residual contrast enhancement) in the postoperative MRI (T1+CM within 48 hours after surgery) in each group. Secondary endpoints are perioperative clinical data, progression free survival, patients' clinical condition and overall survival. The study design was chosen to be a parallel-group approach to compare iMRI and 5-ALA centers (n=13) to exclude possible bias which might be found by randomizing patients within individual iMRI centers and to have surgeons with the most experience possible in use of each respective technology.

Recruitment Criteria

Accepts Healthy Volunteers

Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms

No
Study Type

An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.


An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.


Searching Both is inclusive of interventional and observational studies.

Interventional
Eligible Ages 18 Years - 80 Years
Gender All
More Inclusion & Exclusion Criteria

Inclusion Criteria:

1. In MRI suspected primary singular untreated GBM. 2. Planned total resection of the tumor according to the surgeon. 3. Patient ≥18 years, ≤80 years. 4. Preoperative KPS ≥ 60%, American Society of Anesthesiologists (ASA) score 1 and 2. 5. Patients' informed consent.

Exclusion Criteria:

1. Tumors of the midline, basal ganglia, cerebellum, brain stem, eloquent areas. 2. Multifocal glioblastoma. 3. Substantial (>50%), non-contrast enhancing tumor areas suggesting low-grade glioma with malignant transformation. 4. Contraindications to MRI. 5. Inability to give consent because of language barrier or dysphasia. 6. Histological diagnosis other than Glioblastoma multiforme WHO °IV. 7. Increased risk of thrombosis (e.g. Factor V Leiden) 8. Pregnancy or breast feeding. 9. Hypersensibility for 5-ALA oder porphyrins. 10. Acute or chronic Porphyria. 11. Renal insufficiency. 12. Hepatic insufficiency. 13. High likelihood of inability to receive adjuvant therapy

Trial Details

Trial ID:

This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.

NCT02379572
Phase

Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.

Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.

Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.

Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.

N/A
Lead Sponsor

The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.

University Hospital Tuebingen
Principal Investigator

The person who is responsible for the scientific and technical direction of the entire clinical study.

Constantin Roder, Dr.
Principal Investigator Affiliation University Hospital Tuebingen, Department of Neurosurgery
Agency Class

Category of organization(s) involved as sponsor (and collaborator) supporting the trial.

Other
Overall Status Completed
Countries Germany
Conditions

The disease, disorder, syndrome, illness, or injury that is being studied.

Glioblastoma
Arms & Interventions

Arms

Experimental: iMRI-guided surgery

Resection of Glioblastomas with iMRI-guidance

Active Comparator: 5-ALA-guided surgery

Resection of Glioblastomas with 5-ALA-fluorescence-guidance

Interventions

Device: - iMRI-guided surgery

For iMRI-guided glioma resections the surgery can be paused and a direct intraoperative resection control is possible by performing an intraoperative MRI scan. If residual tumor is found, the resection might be continued.

Drug: - 5-ALA-guided surgery

For 5-ALA guided glioma resections patients have to drink 100ml of a solution with 5-Aminolevulinic acid 4-6 hours before surgery. Intraoperatively the light source of the surgical microscope can be switched to a certain wave length to enable fluorescence of the glioma cells, which helps resecting the tumor as radical as possible.

Contact a Trial Team

If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.

International Sites

Bonn, Germany

Status

Address

Department of Neurosurgery, Universitätsklinikum Bonn, Bonn, Germany

Bonn, ,

Cologne, Germany

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Department of Neurosurgery, Universität zu Köln, Köln, Germany

Cologne, ,

Dresden, Germany

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Städtisches Klinikum Dresden Friedrichstadt

Dresden, ,

Düsseldorf, Germany

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Department of Neurosurgery, Heinrich-Heine-Universität Düsseldorf, Düsseldorf

Düsseldorf, ,

Erlangen, Germany

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Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nürnberg

Erlangen, ,

Frankfurt a.M., Germany

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Department of Neurosurgery, Johann Wolfgang Goethe-University Frankfurt am Main

Frankfurt a.M., ,

Göttingen, Germany

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Department of Neurosurgery, Georg-August-Universität Göttingen, Göttingen,

Göttingen, ,

Günzburg, Germany

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Department of Neurosurgery, University of Ulm, Hospital Günzburg,

Günzburg, ,

Hamburg, Germany

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Asklepios Klinik Hamburg, Klinik für Neurochirurgie

Hamburg, ,

Hannover, Germany

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International Neuroscience Institute Hannover, Hannover, Germany

Hannover, ,

Heidelberg, Germany

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Department of Neurosurgery, Ruprecht-Karls-University Heidelberg

Heidelberg, ,

Kiel, Germany

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Department of Neurosurgery, University of Schleswig-Holstein, Kiel, Germany

Kiel, ,

Münster, Germany

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Department of Neurosurgery, Westfälische Wilhelms-Universität Münster, Münster, Germany

Münster, ,

Tübingen, Germany

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Address

Department of Neurosurgery, Eberhard Karls University, Tübingen,

Tübingen, ,

Würzburg, Germany

Status

Address

Department of Neurosurgery, Julius-Maximilians-Universität Würzburg

Würzburg, ,