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ACTIVE NOT RECRUITING

NCT05182437

Precision Radiation Treatment for Epilepsy (PRECISION)

Sponsor: Maastricht Radiation Oncology

View on ClinicalTrials.gov

Summary

The PRECISION-study offers a non-invasive, curative intervention for drug-resistant localised epilepsy patients who are not eligible for surgery. The intervention will consist of a single LINAC based SRT treatment and is given by the radiation-oncologist after detailed localisation of the epileptogenic zone with the neurologist, radiologist and neurosurgeon. This intervention will make curative-intent treatment possible where this could otherwise not be given and is a non-invasive and non-competitive alternative to epilepsy surgery. It is expected that the health costs for this curative treatment will not exceed standard treatment, such as lifelong medication and neuromodulation.

Key Details

Gender

All

Age Range

18 Years - Any

Study Type

INTERVENTIONAL

Enrollment

Start Date

2023-12-01

Completion Date

2028-01-01

Last Updated

2025-08-14

Healthy Volunteers

Conditions

Epilepsy

Interventions

RADIATION

LINAC-based Stereotactic Radiotherapy

Target definition: the target volume is defined as the epileptogenic zone (EZ) on all (non) invasive examinations (e.g. 3, 7 Tesla MRI or Stereo-EEG) of the presurgical path. Planning target volume (PTV) = GTV. A single fraction SRT with a prescribed isotoxic dose of 24 Gy to the 100% surrounding isodose. Dose is depending on the proximity and maximum tolerable dose to the radiosensitive organs at risk and EZ volume resulting in a V12\<= 10 cc reducing the risk on radionecrosis.

Inclusion Criteria: 1. Age ≥ 18 years 2. Before patient registration/randomization, written informed consent must be given according to ICH/GCP, and national/local regulations 3. Willingness to use contraception by a method that is deemed effective by the Investigator during the SRT treatment and for at least 30 days following the SRT therapy 4. The patient or caretaker is able to keep an epilepsy diary 5. The patient has a diagnosis of epilepsy established by a dedicated neurologist 6. The patient had at least 3 focal-onset seizures over a 3-month period despite two or more antiepileptic medication trials (according ILAE Task Force on therapeutic strategies) 7. Video electroencephalography and work-up in the epilepsy surgery working group to determine a well-circumscribed seizure focus is available 8. Evidence (e.g. 3T-MRI or a clear SEEG delineation) of the anatomic region to be targeted with SRT, correlating with the EZ hypothesis; 9. A functional MRI to lateralize language or localize visual, motor and/or sensory eloquent cortex has been performed in selected patients (if the lesion is expected to be located, based on anatomy, in the language areas). 10. The patient has completed a standard battery of neuropsychological testing 11. The patient been deemed an appropriate candidate for stereotactic radiosurgery by a dedicated Radiation Oncologist and Neurosurgeon/Epileptologist and referred for the study by one of the Dutch regional multidisciplinary epilepsy surgery working groups 12. Patients that were rejected for surgery in an earlier stage can participate in the trial if the last change of the NVS/DBS settings were more than 1 year ago or NVS/DBS was not (yet) tried. Exclusion Criteria: 1. Pregnancy 2. If a radiation treatment plan without exceeding the constraints for the organs at risk is not feasible. 3. Prior cranial radiotherapy 4. If radiotherapy treatment is not possible for diverse reasons. 5. If the subject has clinically significant and uncontrolled major other medical condition(s) including but not limited to: ii. psychiatric illness/social situation that would limit compliance with study requirements iii. any medical condition, with the opinion of the study investigator, places the subject at an unacceptably high risk for toxicities iv. Progressive co-morbidity which limits overall survival.

Locations (1)

Maastricht Radiation Oncology

Maastricht, Limburg, Netherlands