Recruiting
Not applicable
Research on the Optimization of Treatment for Spinal Metastases With Radioactive Particle Implantation Using TPS and Mechanical Dual Simulation
Condition(s) studied
Bone Metastases in Subjects With Advanced Cancer
Investigational drug(s) / intervention(s)
Dual-Simulation TPS + Biomechanical PlanningConventional TPS Planning
Dual-Simulation TPS + Biomechanical Planning: Combines TG-43-based TPS with a patient-specific FE biomechanical model to optimize needle paths and seed placement considering OAR limits, fracture risk, needle stability, and seed migration risk.
Conventional TPS Planning: Conventional TPS-driven plan per institutional practice; no biomechanical modeling.
Study summary
This prospective, open-label randomized trial evaluates a dual-simulation planning strategy that combines standard brachytherapy TPS with patient-specific biomechanical modeling for radioactive seed implantation in bone metastases. The approach aims to improve dose coverage while accounting for fracture risk, needle path stability, and seed migration. Eligible patients with painful and/or progressive bone metastases are randomized to dual-simulation planning versus conventional TPS. All undergo image-guided implantation with post-implant dosimetric verification and standardized follow-up. The primary endpoint is 3-month pain response (BPI/VAS, adjusted for analgesic use). Secondary endpoints include dosimetry (D90, V100, CI, HI), local control/progression, seed migration, skeletal-related events and fractures, SINS and functional status, quality of life, procedure-related complications (CTCAE v5.0), and procedure metrics. We hypothesize the dual-simulation strategy will enhance dosimetric quality and reduce biomechanics-related complications, improving pain and function.
Eligibility
Inclusion Criteria:
* Age ≥18 years.
Radiologically or histologically confirmed bone metastasis with a lesion suitable for percutaneous radioactive seed implantation (e.g., I-125), per multidisciplinary assessment.
Indication for local palliation/control: moderate-to-severe pain at lesion (e.g., BPI/VAS ≥4) and/or imaging evidence of progression or high-risk features warranting local therapy.
Measurable/evaluable target lesion on CT/MRI; target location accessible for needle placement per institutional practice.
ECOG performance status 0-2.
Estimated life expectancy ≥3 months.
Adequate hemostasis: platelets ≥80×10\^9/L, INR ≤1.5 (or per protocol), and able to hold/bridge anticoagulation as clinically indicated.
Adequate organ function to undergo the procedure and anesthesia/sedation per site standards.
Able to undergo required imaging (CT; MRI if applicable).
Willing and able to provide written informed consent and comply with follow-up.
For women of childbearing potential and men with partners of childbearing potential: agreement to use effective contraception during and for the protocol-defined period after implantation.
Exclusion Criteria:
* Need for urgent surgical decompression or stabilization (e.g., acute/impending neurologic compromise, unstable pathologic fracture) that precludes percutaneous implantation at this time.
Uncorrected coagulopathy or ongoing antithrombotic therapy that cannot be safely managed periprocedurally.
Active systemic or local infection at/near the planned access route.
Diffuse marrow replacement or extensive cortical destruction where percutaneous implantation is unsafe or unlikely to achieve local control without stabilization, per MDT judgment.
Prior radiation or surgery to the index lesion that, in the investigator's opinion, makes additional seed implantation unsafe or non-beneficial; postoperative bed without a discrete target for seed placement.
Known hypersensitivity to materials/agents required for the procedure (e.g., contrast) not amenable to premedication or alternative imaging.
Uncontrolled medical conditions posing prohibitive procedural risk (e.g., severe cardiopulmonary disease, uncontrolled hypertension/arrhythmia).
Pregnant or breastfeeding.
Inability to lie still or contraindications to required imaging/sedation not correctable.
Concurrent participation in another interventional study that could confound efficacy/safety assessment at the treated site.
Any condition that, in the investigator's judgment, would interfere with protocol adherence, safety monitoring, or outcome assessment.
Primary outcome measure(s)
- Pain Response at 3 Months — Baseline (≤14 days pre-implant) and 3 months post-implant (±14 days)
Proportion of participants achieving pain response at the treated site 3 months post-implant, defined as ≥2-point absolute reduction or ≥30% relative reduction from baseline in worst pain (BPI-SF item 3 or 0-10 VAS), without an increase in analgesic consumption; if analgesic use changes, response is adjudicated using standardized analgesic-adjusted criteria (e.g., IMMPACT-consistent rules with oral morphine equivalent dose). Pain is collected by trained staff blinded to allocation; centralized, de-identified adjudication applies. Primary analysis compares proportions between arms (risk difference and 95% CI; two-sided α=0.05). Time Frame: Baseline and 3 months post-implant.
- Local Tumor Control (Treated Site) — 6 months (±30 days), 12 months (±45 days); exploratory at 24 months (±60 days)
Proportion of participants without local progression at the treated lesion, assessed by centralized imaging review. Local progression is defined as any of: (a) ≥20% increase in maximal diameter or volumetric expansion on CT/MRI with an absolute increase of ≥5 mm; (b) new nodular enhancement or soft-tissue extension contiguous with the treated site; (c) unequivocal progression by MD Anderson bone response criteria; or (d) metabolic progression on PET-CT per PERCIST when available. Death without prior local progression is counted as failure in sensitivity analyses; primary analysis censors at last evaluable imaging. Results reported as local control rate and Kaplan-Meier estimates of time to local progression with 95% CIs. Imaging is reviewed by blinded independent radiologists/physicists
Trial sites (1)
| Facility | City | Region | Status |
|---|
| The 960 Hospital of the People's Liberation Army of China |
Jinan |
Shandong |
Recruiting |
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