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Supramarginal Resection in Glioblastoma Guided by Artificial Intelligence

Study Purpose

Glioblastomas are the most common and poorly prognostic primary brain neoplasms. Despite advances in surgical techniques and chemotherapy, the median survival time for these patients remains less than 15 months. This highlights the need for more effective treatments and improved prognostic tools. The globally accepted surgical strategy currently consists of achieving the maximum safe resection of the enhancing tumor volume. However, the non-enhancing peritumoral region contains viable cells that cause the inevitable recurrence that these patients face. Clinicians currently lack an imaging tool or modality to differentiate neoplastic infiltration in the peritumoral region from vasogenic edema. In addition, it is not always feasible to include all the T2-FLAIR signal alterations surrounding the enhancing tumor in the surgical planning due to the proximity of eloquent areas and the higher risk of postoperative deficits. However, the investigators have developed a model to predict regions of recurrence based on machine learning and MRI radiomic features that have been trained and evaluated in a multi-institutional cohort. The investigators aim to analyze whether an adjusted supramarginal resection guided by these new recurrence probability maps 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 - 80 Years
Gender All
More Inclusion & Exclusion Criteria

Inclusion Criteria:

  • - A suspected diagnosis of supratentorial glioblastoma by MRI.
  • - Tumor in non eloquent brain region according to the UCSF (University of California, San Francisco) classification, including the sensor motor areas (precentral and postcentral gyri), perisylvian language areas in the dominant hemisphere (superior temporal, inferior frontal, and inferior parietal gyri), basal ganglia, internal capsule, thalamus, and visual cortex around the calcarine sulcus.
  • - 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. This criterion needs to be verified by two senior neurosurgeons.
  • - Karnofsky Performance Score ≥ 60; - Written informed consent.

Exclusion Criteria:

  • - Tumors in eloquent areas.
  • - Recurrent gliomas (except biopsy) - MR image data not usable due to artifacts during acquisition.
Inability to give written informed consent.
  • - KPS < 60.
  • - Severe comorbidity.

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.

NCT05735171
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.

Hospital del Río Hortega
Principal Investigator

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

Santiago Cepeda, PhD
Principal Investigator Affiliation Hospital Río Hortega
Agency Class

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

Other
Overall Status Recruiting
Countries Spain
Conditions

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

Glioblastoma
Additional Details

The SupraGlio-AI study aims to test the feasibility of the proposed AI-guided tailored supratotal resection for glioblastomas. The study will provide preliminary data on the accuracy of the AI model in predicting recurrence and the impact of using this information in surgical planning. This information will be crucial in determining the potential for a larger, randomized controlled trial in the future. The pilot study will also allow for refinement of the study design, intervention, and data collection processes before a larger-scale study is conducted. In addition to testing the feasibility and efficacy of the AI-guided tailored supratotal resection, this pilot study also has two secondary objectives: 1) Survival Analysis: A survival analysis will be performed to compare the prospective cohort of patients undergoing the AI-guided procedure with a retrospective cohort of glioblastoma patients who underwent standard gross total resection. The survival analysis will provide insights into the impact of using the AI model on patient outcomes and help determine the potential benefits of this approach. 2) Histopathological and Transcriptomic Analysis: The study will also include a histopathological and transcriptomic analysis of the tissue samples obtained from the high-risk regions defined by the AI model. This analysis will provide information on the molecular and cellular changes occurring in these regions and may offer insights into the underlying biology of glioblastoma recurrence. These data will inform the development of future studies aimed at improving patient outcomes. By incorporating these secondary objectives, this pilot study will contribute to a more comprehensive understanding of the potential benefits of using AI in guiding tailored supratotal resection for glioblastomas. The results will inform future research and potentially lead to the development of improved treatment approaches for patients with this type of brain tumor.

Arms & Interventions

Arms

Active Comparator: Conventional gross total resection surgery

Retrospective cohort of patients who underwent conventional surgery between 2018 and 2021. Confirmed gross total resection (removal of 100 % of contrast-enhancing tumor).

Experimental: AI-guided resection

Tailored supramarginal surgery guided by AI-based recurrence probability maps. Aim of supramarginal resection, where the high-risk of recurrence areas identified by the AI-based model are subsidiary to be removed as safe locations for the patient.

Interventions

Procedure: - GTR surgery

Gross total resection of the enhancing tumor volume

Procedure: - AI-guided surgery

Supramarginal resection including high-risk areas of recurrence

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

Hospital Universitario de La Princesa, Madrid, Spain

Status

Active, not recruiting

Address

Hospital Universitario de La Princesa

Madrid, , 28006

University Hospital Rio Hortega, Valladolid, Spain

Status

Recruiting

Address

University Hospital Rio Hortega

Valladolid, , 47012

Site Contact

Santiago Cepeda, MD., PhD.

[email protected]

+34651035158