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Supramarginal Resection in Glioblastoma

Study Purpose

Gliomas are the most common malignant brain tumor. Glioblastoma, WHO grade IV astrocytoma, is the most common subtype and unfortunately also the most aggressive subtype with median survival in population based cohorts being only 10 months. Extensive surgical resections followed by postoperative fractioned radiotherapy and concomitant and adjuvant temozolomide prolong survival and is the standard treatment. The investigators think there is significant potential in individualized surgical decision-making in glioblastoma management. The idea that some patients are amendable to radical surgery, while others should be treated more conservatively, is not controversial in other fields of oncology. The current concept in all patients with glioblastoma is "maximum safe resection of the contrast enhancing tumor", but this may in selected cases be extended to simply "maximum safe resection" tailored to the patient and extent of disease at hand. Densely proliferating tumor cells have been found from at an average of 10 mm beyond the margins of contrast enhancement in high-grade gliomas. There are now several case series, using various definitions of supramarginal resection, but they have in common that they report a benefit of resection with a margin. This potential benefit also comes together with an associated neurological risk, making this approach unethical and simply not feasible in the patients with glioblastoma as a whole. Objective of this study is: To investigate if resection with a margin, that is significantly beyond the radiological contrast enhancement, improves survival in selected patients with glioblastoma.

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 and Over
Gender All
More Inclusion & Exclusion Criteria

Inclusion Criteria:

1. A suspected diagnosis of supratentorial glioblastoma by MRI.(A) 2. Indication for surgical treatment and where supramarginal resection is considered possible according to the preoperative imaging. This consideration needs to be verified by two specialists in neurosurgery. 3. Negative work-up for other primary tumor(B) 4. Karnofsky performance status of 70
  • - 100.
A) If randomized to supramarginal surgery, intraoperative frozen section must conclude with "high-grade glioma" to be able to proceed. Surgery in two sessions is also possible in supramarginal group if there is no intraoperative frozen section available or frozen section indicate another diagnosis, but final histopathology reveals a glioblastoma. In case of surgery in two session, there must be no more than 30 days between procedures. See flow-chart in attachment 1. B) No suspected primary tumor seen on CT chest, abdomen and pelvis. If relevant symptoms/clinical suspicion also supplement with mammography, dermatologist exam, relevant endoscopies etc.

Exclusion Criteria:

1. Not willing to be randomized. 2. Informed consent not possible (e.g. language barriers, aphasia, cognitive severely impaired). 3. Contrast enhancement volume bilateral OR involving corpus callosum. 4. Contrast enhancement along the ependymal lining of ventricles (contact is however not an exclusion criteria). 5. Contrast enhancement involving several lobes. 6. History of major psychiatric disorder such as psychosis, schizophrenia and/or mood disorder (e.g. depression and bipolar disorder) in need of hospitalization. 7. Unfit for participation for any other reason judged by the including physician

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.

NCT04243005
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.

St. Olavs Hospital
Principal Investigator

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

Asgeir S Jakola, MD, PhDGeir Bråthen, MD, PhD
Principal Investigator Affiliation St.Olavs University Hospital and Sahlgrenska University HospitalSt. Olavs Hospital
Agency Class

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

Other
Overall Status Recruiting
Countries Austria, Denmark, Finland, Norway, Sweden
Conditions

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

Glioblastoma
Arms & Interventions

Arms

Active Comparator: Conventional surgery

Aim of gross total resection (i.e. removal of contrast enhancing tumor) according to institutional practice. No limit in use of technical adjuncts in this arm.

Experimental: Supramarginal surgery

Aim of supramarginal resection, where a margin of at least 10 mm is considered feasible prior to surgery. The resection is guided by the T2 volume (i.e. zone of edema) where removal of as much as possible of this zone (or beyond) is attempted as long as considered safe

Interventions

Procedure: - Supramarginal resection

Aim of supramarginal resection, where a margin of at least 10 mm is considered feasible prior to surgery. The resection is guided by the T2 volume (i.e. zone of edema) where removal of as much as possible of this zone (or beyond) is attempted as long as considered safe

Procedure: - Conventional surgery

Aim of gross total resection (i.e. removal of contrast enhancing tumor) according to institutional practice. No limit in use of technical adjuncts in this arm.

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

Medical University of Vienna, Vienna, Austria

Status

Recruiting

Address

Medical University of Vienna

Vienna, ,

Site Contact

Georg Widhalm

[email protected]

+47 72 57 30 00

Odense University Hospital, Odense, Denmark

Status

Recruiting

Address

Odense University Hospital

Odense, ,

Site Contact

Frants R Poulsen

[email protected]

+47 72 57 30 00

Helsinki University Hospital, Helsinki, Finland

Status

Recruiting

Address

Helsinki University Hospital

Helsinki, ,

Site Contact

Jarno Satopää

[email protected]

+47 72 57 30 00

Kuopio University Hospital, Kuopio, Finland

Status

Recruiting

Address

Kuopio University Hospital

Kuopio, ,

Site Contact

Olli-Pekka Kämäräinen

[email protected]

+47 72 57 30 00

Oulu University Hospital, Oulu, Finland

Status

Recruiting

Address

Oulu University Hospital

Oulu, ,

Site Contact

Sami Tetri

[email protected]

+47 72 57 30 00

Tampere University Hospital, Tampere, Finland

Status

Recruiting

Address

Tampere University Hospital

Tampere, ,

Site Contact

Joonas Haapasalo

[email protected]

+47 72 57 30 00

Turku University Hospital, Turku, Finland

Status

Recruiting

Address

Turku University Hospital

Turku, ,

Site Contact

Ville Vuorinen

[email protected]

+47 72 57 30 00

Haukeland University Hospital, Bergen, Norway

Status

Recruiting

Address

Haukeland University Hospital

Bergen, ,

Site Contact

Ruby Mahesperan

[email protected]

+47 72 57 30 00

Oslo University Hospital, Rikshospitalet, Oslo, Norway

Status

Recruiting

Address

Oslo University Hospital, Rikshospitalet

Oslo, ,

Site Contact

Einar Vik-Mo

[email protected]

+47 72 57 30 00

Ullevål University Hospital, Oslo, Norway

Status

Recruiting

Address

Ullevål University Hospital

Oslo, ,

Site Contact

Eirik Helseth

[email protected]

+47 72 57 30 00

University Hospital North Norway, Tromsø, Norway

Status

Recruiting

Address

University Hospital North Norway

Tromsø, ,

Site Contact

Roar Kloster

[email protected]

+47 72 57 30 00

St Olavs Hospital, Trondheim, Norway

Status

Recruiting

Address

St Olavs Hospital

Trondheim, ,

Site Contact

Ole Solheim

[email protected]

+47 72 57 30 00

Sahlgrenska University Hospital,, Göteborg, Sweden

Status

Recruiting

Address

Sahlgrenska University Hospital,

Göteborg, ,

Site Contact

Asgeir S Jakola

[email protected]

+47 72 57 30 00

Linköping University Hospital, Linköping, Sweden

Status

Recruiting

Address

Linköping University Hospital

Linköping, ,

Site Contact

Peter Milos

[email protected]

+47 72 57 30 00

Skåne University Hospital, Lund, Sweden

Status

Recruiting

Address

Skåne University Hospital

Lund, ,

Site Contact

Gregor Tomasevic

[email protected]

+47 72 57 30 00

Karolinska University Hospital, Stockholm, Sweden

Status

Recruiting

Address

Karolinska University Hospital

Stockholm, ,

Site Contact

Margret Jensdottir

[email protected]

+47 72 57 30 00

University Hospital of Umeå, Umeå, Sweden

Status

Recruiting

Address

University Hospital of Umeå

Umeå, ,

Site Contact

Rickard Sjöberg

[email protected]

+47 72 57 30 00

Uppsala University Hospital, Uppsala, Sweden

Status

Recruiting

Address

Uppsala University Hospital

Uppsala, ,

Site Contact

Mats Ryttlefors

[email protected]

+47 72 57 30 00