Testing proton craniospinal radiation therapy versus the usual radiation therapy for leptomeningeal metastasis

People with breast cancer or non-small cell lung cancer that has spread to the cerebrospinal fluid-filled space that surrounds the brain and spinal cord (leptomeningeal metastasis) may be eligible for this study.

This study is being done to answer the following question: Can we extend your life by delivering proton radiation therapy to the entire space that surrounds the brain and spinal cord? We are doing this study because we want to find out if this approach is better or worse than the usual radiation therapy approach for leptomeningeal metastasis (LM). The usual approach is defined as care most people get for LM.

If you decide to take part in this study, you will be randomly assigned to one out of two potential study groups. Study Group 1 will receive photon involved-field radiation therapy, which is the usual type of treatment for this type of cancer. You will get radiation to specific areas of LM that are causing and/or may cause symptoms. Study Group 2 will receive proton craniospinal radiation therapy to the entire space containing the cerebrospinal fluid, brain, and spinal cord where LM is located. Both groups will receive radiation therapy 5 days a week for a total of 10 days of treatment.

The usual radiation therapy approach for patients who are not in a study is treatment with photon involved-field radiation therapy to treat only the areas causing symptoms or may cause symptoms from LM such as the entire brain, part of the spinal cord, and/or base of the skull. The usual radiation therapy can reduce and prevent symptoms and may stop LM from getting worse at the treatment areas.

If you choose to take part in this study, there is a risk that the study approach may not be as good as the usual approach for your cancer at stabilizing your cancer. There is also a risk that you could have side effects from the study approach. These side effects may be worse and may be different than you would get with the usual approach for your cancer. Your doctor will review all of the potential side effects with you. There may be some risks that the study doctors do not yet know about.

There is evidence that this proton craniospinal radiation therapy is effective in stabilizing your type of cancer. It is not possible to know now if the study approach will extend your life compared to the usual approach. This study will help doctors learn things that will help people in the future.

After you finish your treatment, your doctor and study team will watch you for side effects. They will check you every 3 months for 1 year, then every 6 months for 1 year. These visits may be in-person or by telehealth. After 2 years, your study doctor will check in with you and continue to follow your condition approximately every 6 months for the next 3 years, but this will not require an in-person doctor visit. This means your study doctor will follow you for 5 years after your treatment.

No. Taking part in this study is voluntary. You are free to choose to participate or not to participate. If you choose to participate in this study, you are able to leave the study at any time. If you decide not to take part in this study, your doctor will discuss other treatment options with you.

You and/or your insurance plan will need to pay for the costs of medical care you get as part of the study, just as you would if you were getting the usual care for your cancer. This includes:

• the costs of tests, exams, procedures, and drugs that you get during the study to monitor your safety, and prevent and treat side effects; 
• the costs of getting either the proton craniospinal radiation therapy or the usual photon involved-field radiation therapy; 
• your insurance co-pays and deductibles.

Talk to your insurance provider and make sure that you understand what your insurance pays for and what it doesn’t pay for if you take part in this clinical trial. Also, find out if you need approval from your plan before you can take part in the study. 

You will not be paid for taking part in this study.

Your privacy is very important to us and the researchers will make every effort to protect it. Your information may be given out if required by law. For example, certain states require doctors to report to health boards if they find a disease like tuberculosis. However, the researchers will do their best to make sure that any information that is released will not identify you. Some of your health information and/or information about your specimens from this study will be kept in a central database for research. Your name or contact information will not be put in the database.

There are organizations that may inspect your records. These organizations are required to make sure your information is kept private, unless required by law to provide information. Some of these organizations are:

• NRG Oncology and any company supporting the study now or in the future. This would include any organization helping the company with the study. 
• The National Cancer Institute (NCI) Central Investigational Review Board (IRB), which is a group of people who review the research with the goal of protecting the people who take part in the study. 
• The Food and Drug Administration (FDA) and the groups it works with to review research. 
• The NCI and the groups it works with to review research, including the Cancer Trials Support Unit (CTSU). 
• The NCI’s National Clinical Trials Network and the groups it works with to conduct research including the Imaging and Radiation Oncology Core (IROC]. 
• VisionTree, Inc. (if you consent to completing questionnaires electronically your responses to questionnaires will be collected).

Doctors and researchers conduct a clinical study, also called a “clinical trial,” to find better ways to prevent, diagnose, or treat an illness. NRG Oncology is supported by the National Cancer Institute (NCI) and runs clinical studies specifically for patients with cancer or to prevent cancer. Most clinical studies test something we know against something we don’t know. In all situations, these studies are strictly evaluated before they are allowed to be offered to any patient. The study is designed to answer the question that we do not know the answer to, so that current and future patients may have better treatments or information than what we currently have. There are different types of clinical studies that might be available for patients. For more information see “Types of Clinical Trials” and “Phases of Clinical Trials”.

Patients who volunteer to take part in a clinical study are followed closely by their health care professionals and members of the research team. For more information see “Research Team Members”.

Yes. They are exactly the same thing.

The care cancer doctors provide to cancer patients today is the direct result of clinical studies (also known as clinical trials) that were done in the past. Clinical studies give doctors and the treatment team information about what types of treatments work and what treatments do not work, in a number of different situations. Some studies focus on treating the cancer, others on preventing the cancer, and others on helping patients feel better or healthier during or after treatments. When you take part in a clinical study, you add to our knowledge about cancer and it may help improve cancer care for future patients. Clinical studies are available to patients with many types of cancer and at all stages of treatment. In some situations, the only way to get these new treatments is by joining a clinical study.

A clinical study may take place in many locations, such as:

physician offices

hospitals

clinics

A study is typically led by a principal investigator who is a doctor or other advanced health care professional. A clinical study is carried out by following a very specific plan known as the “protocol”. The protocol is designed so all patients in the study are treated as well as possible and in the same way. The protocol also provides rules for the doctors and clinical study staff to follow to keep patients safe and make sure the study is run in an ethical manner.

No, not at all. Participation in a clinical study is completely voluntary. For more information see “Deciding to Take Part in a Clinical Trial”. You are free to choose to participate or not to participate. If you choose to participate in a study, you may still decide to leave the study at any time. If you decide not to participate in a study, your doctor will discuss other treatment options with you. For more information see “Questions to Ask Your Doctor about Treatment Clinical Trials".

• You may choose to have the usual treatment approach (known as “standard of care”)
• You may choose to take part or learn more about a different study, if one is available
• You may choose not to be treated for cancer