SCRT :- Stereotactic Conformal Radiotherapy  (SCRT) Trial

SCRT Trial :
Brain tumours are the commonest solid tumours in children and the second most common neoplasms overall in this patient population. Radiotherapy plays an important part in the management in a majority of these tumours. While the cure rates of these tumours, especially the benign and low grade ones are quite encouraging, the treatment itself may lead to some late sequelae, which could have significant implications in the quality of life in these long-term survivors.

Stereotactic conformal radiotherapy (SCRT) is a modern high-precision radiotherapy technique, which reduces the volume of normal brain irradiated and has the capability to minimise the doses to critical structures. The present study is designed to prospectively estimate the incidence and severity of neuropsychological, cognitive and neuroendocrine dysfunction following radiotherapy delivered with conventional and stereotactic techniques and would be one of the most comprehensive studies providing very important longitudinal and reliable data regarding these sequelae. The study would be, to the best of our knowledge not only the largest ever study conducted so far but also the only randomised trial assessing these sequelae in patients receiving focal brain irradiation.

The study also examines whether the physical advantages of modern technological progress translate in clinical benefit. This could have significant implications in the radiotherapeutic management of children and young adults with brain tumours. The study is unique in design in terms of evaluating the efficacy of SCRT with respect to conventional radiotherapy in terms of long term tumour control and treatment related complications.

The SCRT research trial was initiated in May 2001 after being cleared from the hospital scientific and ethics committees including an expert external referee review. The trial has been also reviewed and approved by Dr Wosnick from NCI, Canada in 2003. The trial is ongoing and has accrued 78 patients so far and has also undergone a review by hospital data monitoring and safety committee from time to time. The trial would answer some very important research questions in the management of childhood brain tumours and is among the few examining the efficacy of modern technologies in accordance with the strict rigour of scientific trial methodology.

Part of the results of the trial have already been presented in important scientific conferences with relevant publications, as follows:

1. “Neuropsychological status in children and young adults with benign and low-grade brain tumours
treated prospectively with focal stereotactic conformal radiotherapy.” R Jalali, S Goswami, R Sarin, N More, M Siddha and R Kamble . Int J of Radiat Oncol Biol Physics 2006 (In press).

2. “Maintenance of neuropsychological function in children with benign and low grade brain tumours
treated with high-precision focal conformal radiotherapy.” R Jalali, S Goswami, N More, R Sarin, M Siddha, R Kamble and S Parab. NeuroOncology 2005 7(3):288:391.

Status: ongoing trial. Till date 92 patients have been accrued.