Brain MetastasesNCT03075072
Hippocampal Sparing Whole Brain Radiation Versus Stereotactic Radiation in Patients With 5-20 Brain Metastases: A Phase III, Randomized Trial
A study testing Whole brain radiation and Stereotactic radiation (SRS) in people with Brain Metastases, run by Brigham and Women's Hospital at 2 sites in United States.
Trial summary
This research study is studying two different types of radiation as treatment for brain metastases (tumors in the brain that spread from a cancer that originated elsewhere in the body) Read more about this study
- Who is it for?
- Ages 18 to 80 years
- Conditions the study is for
- Brain Metastases
- What is being tested?
- Whole brain radiation and Stereotactic radiation (SRS)
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 196 participants
- Where
- 2 sitesUnited States
- Study dates
- 10 Apr 2017to 30 Sep 2027
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 80 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Participants must have a biopsy proven solid malignancy with untreated (by radiation) intracranial lesions radiographically consistent with or pathologically proven to be brain metastases. Patients who have undergone prior systemic therapy are eligible
- Five-twenty intracranial lesions must be present on MRI of the brain
- Age 18-80 years at diagnosis of brain metastases
- Karnofsky performance status of at least 70
Who cannot join
- Participants who have undergone prior radiation for brain metastases.
- Patients who have undergone resection of one or more brain metastases but who have not yet started adjuvant radiotherapy are eligible for the study
- Participants who cannot undergo a brain MRI
- Participants who cannot receive gadolinium (MRI contrast)
- Participants with stage IV-V chronic kidney disease or end stage renal disease
- Participants with widespread, definitive leptomeningeal disease
- Participants with small cell lung cancer, lymphoma, or myeloma
- Participants with a maximum tumor diameter exceeding 5 cm (if not resected)
Trial locations and contacts
2 sites in 1 country.
United States2 sites
Brigham and Women's Hospital
Boston, Massachusetts, 02115
Dana Farber Cancer Institute
Boston, Massachusetts, 02116
About this study
Official title: Hippocampal Sparing Whole Brain Radiation Versus Stereotactic Radiation (SRS) in Patients With 5-20 Brain Metastases: A Phase III, Randomized Clinical Trial
This research study is studying two different types of radiation as treatment for brain metastases (tumors in the brain that spread from a cancer that originated elsewhere in the body)
Read the detailed description
This research study is a Phase III clinical trial. Phase III clinical trials examine the safety and effectiveness of a treatment, often comparing it to another known treatment. In this case, the investigators are specifically looking at differences between two forms of radiation treatment in terms of subsequent quality of life.
In this research study, the investigators are comparing stereotactic (focused, pinpoint) radiation (in which each tumor is narrowly targeted) against whole brain radiation (radiation targeting the entire brain) in the treatment of brain metastases. Currently whole brain radiation is the standard option for patients with 5-20 brain metastases. Stereotactic radiation is the standard option for patients with 1-4 brain metastases. Among patients with 1-4 brain metastases, recently published studies suggest that stereotactic radiation results in fewer neurologic side effects than whole brain radiation. It also yields better quality of life in this population. It remains unknown whether stereotactic radiation improves quality of life in patients with 5-20 brain metastases relative to whole brain radiation. In this study, the investigators seek to determine which of the two methods of study treatment results in a better subsequent quality of life for patients with 5-20 brain metastases.
- Conditions
- Brain Metastases
- Being tested
- Whole brain radiation, Stereotactic radiation (SRS)
- Keywords
- Brain metastases, Brain metastasis, Lung cancer, Melanoma, Breast cancer, Kidney cancer, Renal cell carcinoma, Stereotactic radiation, Stereotactic radiosurgery, SRS, Stereotactic, Whole brain radiation, WBRT, Hippocampal avoidance, Hippocampal sparing, Hippocampal, Hippocampus, Radiation, Quality of Life, Neurocognitive
- Medical subject headings
- Brain Neoplasms, Lung Neoplasms, Melanoma, Breast Neoplasms, Kidney Neoplasms, Carcinoma, Renal Cell, Recurrence
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Whole brain radiationRadiation
Treatment of the whole brain with radiation. When possible the hippocampus will be spared from radiation.
Stereotactic radiation (SRS)Radiation
Focused radiation to each individual brain metastasis without treatment of the remainder of the brain.
| Study group | Role | What they receive |
|---|---|---|
| Whole Brain Radiation | Active comparator | * MRI will be performed prior to radiation is administered
* A hippocampal sparing approach will be used when possible
* Dose will be 30 Gy in 10 fractions Receives: Radiation: Whole brain radiation |
| Stereotactic Radiation (SRS) | Experimental | * MRI will be performed prior to radiation is administered
* Radiation will be given in 1-5 fractions (dose depends on the size of the tumor that will be treated) Receives: Radiation: Stereotactic radiation (SRS) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in MD Anderson Symptom Inventory - Brain Tumor (MDASI-BT) Score
Questionnaire - MD Anderson Symptom Inventory - Brain Tumor (MDASI-BT). Results reflect patient-reported symptoms. Here they are presented as a mean change: the difference in the weighted mean of symptom severity and interference scores at baseline versus at 6 months. The difference between these scores is the mean change reported below. The MD Anderson Symptom Inventory has a scale of 0-10, 0 being not present and 10 being as bad as the patient could imagine. The calculated score change has a range of -10 to 10; -10 being the best. Change in score is calculated as the composite weighted means of symptom severity and interference at 6 months minus the composite weighted means of symptom severity and interference at baseline.
Measured: Baseline and 6 months post-Baseline
Secondary outcomes (31)
Overall Survival
Clinical Parameter. Here we report the number of patients analyzed for the outcome as well as the number of deaths that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Neurologic Death
Clinical parameter to be assessed via review of study visits and medical records indicating cause of death (neurologic versus systemic). Here we report the number of patients analyzed for the outcome as well as the number of events that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
12 Month Cumulative Incidence of New Brain Metastases
Radiographic assessment of first appearance of new brain metastases. Here we report the number of patients analyzed for the outcome as well as the number of events that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Local Recurrence of Treated Brain Tumor(s)
Radiographic assessment of first local recurrence in the 5-20 brain metastases that were initially treated with radiation. Here we report the number of patients analyzed for the outcome as well as the number of events that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Progressive Intracranial Disease
Radiographic assessment of first instance of progressive intracranial disease. Here we report the number of patients analyzed for the outcome as well as the number of events that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Radiographic Radiation Necrosis
Radiographic assessment of first appearance of radiation necrosis. Here we report the number of patients analyzed for the outcome as well as the number of events that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Leptomeningeal Disease
Radiographic assessment of first appearance of leptomeningeal disease. Here we report the number of patients analyzed for the outcome as well as the number of events that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Dexamethasone Initiation
Assessing time to dexamethasone initiation in patients who were not taking steroids at enrollment. Here we report the number of patients analyzed for the outcome as well as the number of events that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Development of Seizures
Clinical assessment of first post-treatment seizure as assessed during routine study visits and via medical record review. Here we report the number of patients analyzed for the outcome as well as the number of events that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Salvage Stereotactic Radiation
Clinical assessment of first use of salvage stereotactic radiation. Here we report the number of patients analyzed for the outcome as well as the number of events that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Salvage Whole Brain Radiation
Clinical assessment of first use of salvage whole brain radiation with or without hippocampal avoidance. Here we report the number of patients analyzed for the outcome as well as the number of events that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Salvage Neurosurgical Resection
Clinical assessment of first use of neurosurgical resection as salvage therapy. Here we report the number of patients analyzed for the outcome as well as the number of events that occurred. We then report the 12 Month Cumulative Incidence with a 95% Confidence Interval.
Measured: Through study completion, an average of 1 year
Mean Barthel Index Score at Baseline
Barthel Index ranges from 0 to 100 with higher scores indicating greater functional independence. A greater difference between the groups indicates greater functional independence in the stereotactic arm. Here we report the mean Barthel Index score at baseline for both arms.
Measured: Baseline
Change in Barthel Index Score at 4-months and 12-months Post-baseline
Barthel Index ranges from 0 to 100 with higher scores indicating greater functional independence. A greater difference between the groups indicates greater functional independence in the stereotactic arm. Here we report the mean difference (95% Confidence Interval) at each timepoint.
Measured: 4 Months and 12 months
Karnofsky Performance Status
The Karnofsky Performance Status (KPS) is a tool designed to assess a cancer patient's functional status. Scores range from 0 to 100 with higher scores indicating better function. Scores 90-100 indicate that the patient is independent and can perform daily activities with little to no effort. A score of 80 indicates that the patient can conduct their normal activities with some effort. A score of 70 indicates that a patient can care for themself but cannot carry on normal activities independently. Here we report the least squares mean Karnofsky Performance Score for each arm based on the Karnofsky Performance Status Scale at each timepoint from Baseline to 12 Months post-baseline.
Measured: Baseline to 12 Months
Hopkins Verbal Learning Test-Revised Total Recall Z-Score at Baseline
Here we report the mean Hopkins Verbal Learning Test-Revised Total Recall (HVLT-R Total Recall) z-score in each arm at baseline. The HVLT-R Total Recall test measures rote verbal learning across 3 trials administered in one sitting. Scores were transformed into z scores. Z scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The Z-Score central value is 0 and represents the population mean. Larger positive z scores indicate better neurocognitive function.
Measured: Baseline
Change in Hopkins Verbal Learning Test-Revised Total Recall Mean Z-Score at 4-Months and 12-Months Post-baseline
Here we report the mean Hopkins Verbal Learning Test-Revised Total Recall (HVLT-R Total Recall) z-score in each arm at the given timepoint. The HVLT-R Total Recall test measures rote verbal learning across 3 trials administered in one sitting. Scores were transformed into z scores. Z scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The Z-Score central value is 0 and represents the population mean. Larger positive z scores indicate better neurocognitive function.
Measured: 4 Months and 12 Months
Hopkins Verbal Learning Test-Revised Delayed Recall Z-Score at Baseline
Here we report the mean Hopkins Verbal Learning Test-Revised Delayed Recall Z score at baseline. This test measures delayed memory function. Scores were transformed into z scores. Z scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The Z score central value is 0 and represents the population mean. Larger positive z scores indicate better neurocognitive function.
Measured: Baseline
Change in Hopkins Verbal Learning Test-Revised Delayed Recall Z Scores at 4 Months and 12 Months
Here we report the mean Hopkins Verbal Learning Test-Revised Delayed Recall Z score at the given timepoint. This test measures delayed memory function. Scores were transformed into z scores. Z scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The Z score central value is 0 and represents the population mean. Larger positive z scores indicate better neurocognitive function.
Measured: 4 Months and 12 months post-baseline
Hopkins Verbal Learning Test-Revised Recognition Z Score at Baseline
Here we report the mean Hopkins Verbal Learning Test-Revised Recognition z scores in each arm at baseline. The Hopkins Verbal Learning Test - Revised Recognition measures memory storage and recognition. Scores were transformed into z scores. z Scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The z score central value is 0 and represents the populaion mean. Larger, positive z scores indicate better neurocognitive function. Here we report the mean z score in each arm at baseline.
Measured: Baseline
Change in Hopkins Verbal Learning Test-Revised Recognition Z-score at 4 Months and 12 Months
Here we report the mean Hopkins Verbal Learning Test-Revised Recognition z scores in each arm at the given timepoint. The Hopkins Verbal Learning Test - Revised Recognition measures memory storage and recognition. Scores were transformed into z scores. z Scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The z score central value is 0 and represents the populaion mean. Larger, positive z scores indicate better neurocognitive function. Here we report the mean z score in each arm at the given timepoint.
Measured: 4 Months and 12 Months post baseline
Trail Making Test A, Z Score at Baseline
Here we report the mean Trail Making Test A z score in each arm at baseline. The Trail Making Test A measures visuomotor processing speed. Scores were transformed into z scores. z Scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The z score central value is 0 and represents the population mean. Larger, positive z scores inicate better visuomotor processing speed.
Measured: Baseline
Change in Trail Making Test A Z-Score From Baseline at 4 Months and 12 Months
Here we report the mean Trail Making Test A z score in each arm at the given timepoint. The Trail Making Test A measures visuomotor processing speed. Scores were transformed into z scores. z Scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The z score central value is 0 and represents the population mean. Larger, positive z scores inicate better visuomotor processing speed.
Measured: at 4 Months and 12 Months
Trail Making Test B Z Score at Baseline
Here we report the mean Trail Making Test B z score in each arm at baseline. The Trail Making Test B measures visuomotor processing speed. Scores were transformed into z scores. z Scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The z score central value is 0 and represents the population mean. Larger, positive z scores inicate better visuomotor processing speed.
Measured: Baseline
Trail Making Test B Z Score at 4 Months and 12 Months Post-baseline
Here we report the mean Trail Making Test B z score in each arm at the given timepoint. The Trail Making Test B measures visuomotor processing speed. Scores were transformed into z scores. z Scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The z score central value is 0 and represents the population mean. Larger, positive z scores inicate better visuomotor processing speed.
Measured: 4 Months and 12 months post-baseline
Controlled Oral Word Test Z Score at Baseline
Here we report the mean controlled oral word test z score in each arm at baseline. The controlled oral word test (COWAT) measures verbal fluency. Scores were transformed into z scores. z Scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The z score central value is 0 and represents the population mean. A larger positive z score indicates better performance.
Measured: Baseline
Change in Controlled Oral Word Test Z Score at 4 Months and 12 Months Post Baseline
Here we report the change in mean controlled oral word test z score in each arm at the given timepoints from baseline. The controlled oral word test (COWAT) measures verbal fluency. Scores were transformed into z scores. z Scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The z score central value is 0 and represents the population mean. A larger positive z score indicates better performance.
Measured: 4 Months and 12 months post baseline
Mini-Mental State Examination Mean at Baseline
Here we report the Mini-Mental State Examination mean in each arm at baseline. The Mini-Mental State Examination measures global cognition on a scale from 0 to 30. Higher scores indicate better perfromance.
Measured: Baseline
Change in Mini-Mental State Examination Score at 4 Months and 12 Months Post Baseline
Here we report the change in the mean Mini-Mental State Examination z score in each arm at the given timepoints. The Mini-Mental State Examination Scores measures global cognition on a scale from 0 to 30. Test scores were transformed into z scores Larger positive scores indicate better performance. Z scores greater than 2.0 indicate exceptionally high function, between 1.36 and 2.0 indicate above average function, between 0.68 and 1.35 indicate high average function, between -0.67 and 0.67 indicate average function, between -0.68 and -1.35 indicate low average function, between -1.36 and -2.0 indicate below average function, and less than -2.0 indicate exceptionally low. The Z-Score central value is 0 and represents the population mean. Larger, positive differences indicate better global cognition.
Measured: 4 Months and 12 months post baseline
Medical Outcomes Study Cognitive Functioning Scale-Revised Normative Score at Baseline
Scores global cognition on a scale from 0 to 100. Higher scores indicate better cognitive function. Scores were transformed into normative scores ranging from 7.51 to 58.61. Larger scores indicate better function.
Measured: Baseline
Change in Medical Outcomes Study Cognitive Functioning Scale-Revised Normative Scores at 4 Months and 12 Months Post Baseline
Scores global cognition on a scale from 0 to 100. Higher scores indicate better cognitive function. Scores were transformed into normative scores ranging from 7.51 to 58.61. Larger positive differences indicate better function.
Measured: 4 Months and 12 months post baseline
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Mar 2017
- Study start10 Apr 2017
- Primary completion7 Nov 2024
- Study completion30 Sep 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Brain MetastasesStudies of the same condition, open and under way.
- More trials run by Brigham and Women's HospitalThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 196 participants (actual)
Sponsor and investigators
- Lead sponsor
- Brigham and Women's Hospital
- Sponsor type
- University, hospital or other
- Collaborators
- Dana-Farber Cancer Institute
- Responsible party
- Principal investigator, Ayal A. Aizer, MD, Brigham and Women's Hospital
- Investigators
- Ayal Aizer, MD MHS, Principal investigator, Brigham and Women's Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03075072
- Sponsor's protocol ID
- 16-305
- Status last verified
- Aug 2026
- First submitted
- 1 Mar 2017
- Last updated
- 29 Sep 2026
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- Yes
- Individual data sharing
- No
Publications
Ayal Aizer et al. Stereotactic radiation versus hippocampal avoidance whole brain radiation in patients with 5-20 brain metastases: A multicenter, phase 3 randomized trial.. J Clin Oncol 43, 2011-2011(2025). DOI:10.1200/JCO.2025.43.16_suppl.2011
Aizer A et al. Multicenter, Phase 3 Randomized Trial of Stereotactic Radiation vs. Hippocampal Avoidance Whole Brain Radiation in Patients with 5-20 Brain Metastases: Recurrence, Salvage Therapy, and Mortality Endpoints International Journal of Radiation Oncology, Biology, Physics, 123, S33-S34
Michael Parsons, Kee-Young Shin, Jennifer Nosker, Shyam Tanguturi, Paul Catalano, Daphne Haas-Kogan, Jaroslaw Hepel, Marciana Johnson, Grant Benham, Ivy Ricca, Rifaquatn Rahma, Ayal Aizer, NCOG-20. Stereotactic radiation versus hippocampal avoidant whole brain radiation in patients with 5-20 brain metastases: Cognitive outcomes of 12-month survivors, Neuro-Oncology, Volume 27, Issue Supplement_5, November 2025, Pages v325-v326, https://doi.org/10.1093/neuonc/noaf201.1287
Aizer AA, Shin KY, Catalano PJ, Ricca I, Johnson M, Benham G, Roper K, Spicer B, Mann E, Nosker J, Parsons MW, Mendu ML, Hepel J, Chipidza F, Krishnan M, Shi DD, Lamba N, Pashtan I, Peng L, Alexander B, Brown PD, Wen PY, Haas-Kogan DA, Rahman R, Tanguturi S. Treatment for Brain Metastases With Stereotactic Radiation vs Hippocampal-Avoidance Whole Brain Radiation: A Randomized Clinical Trial. JAMA. 2026 Apr 7;335(13):1127-1136. doi: 10.1001/jama.2026.0076.
PubMed 41712219
Study at a glance
From the registry record, last updated by the sponsor on 29 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Hippocampal Sparing Whole Brain Radiation Versus Stereotactic Radiation (SRS) in Patients With 5-20 Brain Metastases: A Phase III, Randomized Clinical Trial
- ClinicalTrials.gov ID
- NCT03075072
- Acronym / sponsor ID
- 16-305
- Conditions
- Brain Metastases
- Keywords
- Brain metastases, Brain metastasis, Lung cancer, Melanoma, Breast cancer, Kidney cancer, Renal cell carcinoma, Stereotactic radiation
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 196 participants (actual)
- Lead sponsor
- Brigham and Women's HospitalUniversity, hospital or other
- Collaborators
- Dana-Farber Cancer Institute
- Study start
- 10 Apr 2017 (actual)
- Primary completion
- 7 Nov 2024 (actual)
- Study completion
- 30 Sep 2027 (estimated)
- First posted
- 9 Mar 2017 (actual)
- Results
- Posted 29 Sep 2026
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This research study is studying two different types of radiation as treatment for brain metastases (tumors in the brain that spread from a cancer that originated elsewhere in the body)
Detailed description
This research study is a Phase III clinical trial. Phase III clinical trials examine the safety and effectiveness of a treatment, often comparing it to another known treatment. In this case, the investigators are specifically looking at differences between two forms of radiation treatment in terms of subsequent quality of life.
In this research study, the investigators are comparing stereotactic (focused, pinpoint) radiation (in which each tumor is narrowly targeted) against whole brain radiation (radiation targeting the entire brain) in the treatment of brain metastases. Currently whole brain radiation is the standard option for patients with 5-20 brain metastases. Stereotactic radiation is the standard option for patients with 1-4 brain metastases. Among patients with 1-4 brain metastases, recently published studies suggest that stereotactic radiation results in fewer neurologic side effects than whole brain radiation. It also yields better quality of life in this population. It remains unknown whether stereotactic radiation improves quality of life in patients with 5-20 brain metastases relative to whole brain radiation. In this study, the investigators seek to determine which of the two methods of study treatment results in a better subsequent quality of life for patients with 5-20 brain metastases.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Whole Brain Radiation | Active comparator | Radiation: Whole brain radiation* MRI will be performed prior to radiation is administered * A hippocampal sparing approach will be used when possible * Dose will be 30 Gy in 10 fractions |
| Stereotactic Radiation (SRS) | Experimental | Radiation: Stereotactic radiation (SRS)* MRI will be performed prior to radiation is administered * Radiation will be given in 1-5 fractions (dose depends on the size of the tumor that will be treated) |
Who may qualify
- Ages
- 18 to 80 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Participants must have a biopsy proven solid malignancy with untreated (by radiation) intracranial lesions radiographically consistent with or pathologically proven to be brain metastases. Patients who have undergone prior systemic therapy are eligible
- Five-twenty intracranial lesions must be present on MRI of the brain
- Age 18-80 years at diagnosis of brain metastases
- Karnofsky performance status of at least 70
Key exclusion criteria (8 listed)
- Participants who have undergone prior radiation for brain metastases.
- Patients who have undergone resection of one or more brain metastases but who have not yet started adjuvant radiotherapy are eligible for the study
- Participants who cannot undergo a brain MRI
- Participants who cannot receive gadolinium (MRI contrast)
- Participants with stage IV-V chronic kidney disease or end stage renal disease
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Whole brain radiationTreatment of the whole brain with radiation. When possible the hippocampus will be spared from radiation. | Radiation | Whole Brain Radiation |
| Stereotactic radiation (SRS)Focused radiation to each individual brain metastasis without treatment of the remainder of the brain. | Radiation | Stereotactic Radiation (SRS) |
Primary outcome
Change in MD Anderson Symptom Inventory - Brain Tumor (MDASI-BT) Score
Time frame: Baseline and 6 months post-Baseline
Questionnaire - MD Anderson Symptom Inventory - Brain Tumor (MDASI-BT). Results reflect patient-reported symptoms. Here they are presented as a mean change: the difference in the weighted mean of symptom severity and interference scores at baseline versus at 6 months. The difference between these scores is the mean change reported below. The MD Anderson Symptom Inventory has a scale of 0-10, 0 being not present and 10 being as bad as the patient could imagine. The calculated score change has a range of -10 to 10; -10 being the best. Change in score is calculated as the composite weighted means of symptom severity and interference at 6 months minus the composite weighted means of symptom severity and interference at baseline.
31 secondary outcomes
Overall Survival
Time frame: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Neurologic Death
Time frame: Through study completion, an average of 1 year
12 Month Cumulative Incidence of New Brain Metastases
Time frame: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Local Recurrence of Treated Brain Tumor(s)
Time frame: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Progressive Intracranial Disease
Time frame: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Radiographic Radiation Necrosis
Time frame: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Leptomeningeal Disease
Time frame: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Dexamethasone Initiation
Time frame: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Development of Seizures
Time frame: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Salvage Stereotactic Radiation
Time frame: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Salvage Whole Brain Radiation
Time frame: Through study completion, an average of 1 year
12 Month Cumulative Incidence of Salvage Neurosurgical Resection
Time frame: Through study completion, an average of 1 year
Mean Barthel Index Score at Baseline
Time frame: Baseline
Change in Barthel Index Score at 4-months and 12-months Post-baseline
Time frame: 4 Months and 12 months
Karnofsky Performance Status
Time frame: Baseline to 12 Months
Hopkins Verbal Learning Test-Revised Total Recall Z-Score at Baseline
Time frame: Baseline
Change in Hopkins Verbal Learning Test-Revised Total Recall Mean Z-Score at 4-Months and 12-Months Post-baseline
Time frame: 4 Months and 12 Months
Hopkins Verbal Learning Test-Revised Delayed Recall Z-Score at Baseline
Time frame: Baseline
Change in Hopkins Verbal Learning Test-Revised Delayed Recall Z Scores at 4 Months and 12 Months
Time frame: 4 Months and 12 months post-baseline
Hopkins Verbal Learning Test-Revised Recognition Z Score at Baseline
Time frame: Baseline
Change in Hopkins Verbal Learning Test-Revised Recognition Z-score at 4 Months and 12 Months
Time frame: 4 Months and 12 Months post baseline
Trail Making Test A, Z Score at Baseline
Time frame: Baseline
Change in Trail Making Test A Z-Score From Baseline at 4 Months and 12 Months
Time frame: at 4 Months and 12 Months
Trail Making Test B Z Score at Baseline
Time frame: Baseline
Trail Making Test B Z Score at 4 Months and 12 Months Post-baseline
Time frame: 4 Months and 12 months post-baseline
Controlled Oral Word Test Z Score at Baseline
Time frame: Baseline
Change in Controlled Oral Word Test Z Score at 4 Months and 12 Months Post Baseline
Time frame: 4 Months and 12 months post baseline
Mini-Mental State Examination Mean at Baseline
Time frame: Baseline
Change in Mini-Mental State Examination Score at 4 Months and 12 Months Post Baseline
Time frame: 4 Months and 12 months post baseline
Medical Outcomes Study Cognitive Functioning Scale-Revised Normative Score at Baseline
Time frame: Baseline
Change in Medical Outcomes Study Cognitive Functioning Scale-Revised Normative Scores at 4 Months and 12 Months Post Baseline
Time frame: 4 Months and 12 months post baseline
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 Sep 2026.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Results publicationAyal Aizer et al. Stereotactic radiation versus hippocampal avoidance whole brain radiation in patients with 5-20 brain metastases: A multicenter, phase 3 randomized trial.. J Clin Oncol 43, 2011-2011(2025). DOI:10.1200/JCO.2025.43.16_suppl.2011
- Results publicationAizer A et al. Multicenter, Phase 3 Randomized Trial of Stereotactic Radiation vs. Hippocampal Avoidance Whole Brain Radiation in Patients with 5-20 Brain Metastases: Recurrence, Salvage Therapy, and Mortality Endpoints International Journal of Radiation Oncology, Biology, Physics, 123, S33-S34
- Results publicationMichael Parsons, Kee-Young Shin, Jennifer Nosker, Shyam Tanguturi, Paul Catalano, Daphne Haas-Kogan, Jaroslaw Hepel, Marciana Johnson, Grant Benham, Ivy Ricca, Rifaquatn Rahma, Ayal Aizer, NCOG-20. Stereotactic radiation versus hippocampal avoidant whole brain radiation in patients with 5-20 brain metastases: Cognitive outcomes of 12-month survivors, Neuro-Oncology, Volume 27, Issue Supplement_5, November 2025, Pages v325-v326, https://doi.org/10.1093/neuonc/noaf201.1287
- Results publication: PubMed 41712219Aizer AA, Shin KY, Catalano PJ, Ricca I, Johnson M, Benham G, Roper K, Spicer B, Mann E, Nosker J, Parsons MW, Mendu ML, Hepel J, Chipidza F, Krishnan M, Shi DD, Lamba N, Pashtan I, Peng L, Alexander B, Brown PD, Wen PY, Haas-Kogan DA, Rahman R, Tanguturi S. Treatment for Brain Metastases With Stereotactic Radiation vs Hippocampal-Avoidance Whole Brain Radiation: A Randomized Clinical Trial. JAMA. 2026 Apr 7;335(13):1127-1136. doi: 10.1001/jama.2026.0076.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Ayal Aizer, MD MHS principal investigator
Brigham and Women's Hospital
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Whole brain radiation and Stereotactic radiation (SRS) in people with Brain Metastases, run by Brigham and Women's Hospital at 2 sites in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: under way, not looking for participants, as of the sponsor's last update on 29 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 29 Sep 2026). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in MD Anderson Symptom Inventory - Brain Tumor (MDASI-BT) Score (time frame: Baseline and 6 months post-Baseline). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03075072, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Sep 2026; AzTrials last refreshed its copy on 26 Oct 2026.