학술논문

Feasibility of comparing medical management and surgery (with neurosurgery or stereotactic radiosurgery) with medical management alone in people with symptomatic brain cavernoma – protocol for the Cavernomas: A Randomised Effectiveness (CARE) pilot trial
Document Type
article
Author
Khalid HamandiJulie WoodfieldSmriti AgarwalRichard EdwardsJohn WilliamsonRavindran VisaganRustam Al-Shahi SalmanHoward BrydonDiederik BultersDawn HenniganPaul LeachConor MallucciNitin MukerjiMarios PapadopoulosNicholas RossMartin TisdallCarole TurnerShungu UshewokunzeRaghu VindlacheruvuPaul BrennanPhil WhiteSophie HunterKaren CoyJulia WadeJames StewartTom HughesLaura ForsythKirsty HarknessDavid WhiteRupal ShahSanjay BhateNeil KitchenPeter J HutchinsonEmanuel CirsteaRamesh NairRebecca HallVarduhi CahillTom HaytonSilvia TarantinoChristin EltzeJack LeeArlo WhitehouseDaniel WalshJacqueline StephenNicola PhillipsSteff LewisSusan DaviesMathew GuilfoylePeter S HallAndrew StoddartFrancesca ColomboEmma RichardsGreg JamesSarah IllingworthWilliam B LoAndrew BaconVijeya GanesanSabina PatelAileen R NeilsonFelicia JenningsSaba Raza-KnightAndrew BrodbeltAswin ChariHasan AsifIan Kamaly-AslMilan MakwanaZubair TahirAllan MacRaildGrace VassalloIan AndersonDaniel HolsgroveCarole ChambersSandra WilliamsFrancesca Spickett-JonesMarios C PapadopoulosJohn PrestonEdward WhiteAdel HelmySarah AliJohn ReidDaniel BrownLouis TaylorChristopher UffPatrick GroverAzra BanarasLinetty MakawaAnil IsraniRichard J EdwardsWilliam MuirheadDaniel BrooksDebbie BrownCiaran Scott HillKerry SmithBeth AtkinsonMichelle FawcettSifelani TshumaOliver KennionJo HoweJames J M LoanPhilip ClatworthyClaire HudsonRebecca HodnettMadalina RomanMary SikaongaElaine KinsellaMario TeoVenetia GiannakakiJames LoanLauren HarrisJack WildmanEmmanuel ChavredakisNihal GurusingheAlex RossdeutschAnthony WigginsGiannis SokratousLucie FergusonShakeelah PatelSonia RajOishik RahaJanneke van BeijnumPragnesh BhattAnna BjornsonNicole BroomesAlistair BullenJulian CahillMihai DanciutRonneil DigpalIoannis FouyasLauren S HarrisSohail MajeedMatthias RadatzOliver Wroe WrightJessica TeasdaleMichelle CoakleyDrahoslav SokolChandru KaliaperumalMairi MacDonaldSarah RisbridgerSiobhan KearneyEllaine BosettaThomas DokeSonny CoskunerChristine KamaraJonathan GardnerImron HaminaKishor ChaudhariLiliana ChapasKaren CaldwellSarah HollandTamara TajsicRachael DoreTaya AndersonShelley MayorLaura O'MalleySamantha GloverJanice IrvineAnnika WalchFarah MuirEng Tah GohAndrew McDarbyMichelle BatesRebecca HancoxClaudia Kate AuyeungElizabeth GoffDeanna StephensBorislava BorislavovaRuth WornerSandeep BuddhaLisa TuckerSandra DymondAndrew MallickDymona McAleerBelinda GunningEmma ClarksonCathy StoneleyJibril Osman FarahNiamh BohnackerRosette MarimonLydia ParkerPuneet SharmaDan HolsgroveDanielle McLaughlanTracey MarsdenKathryn CawleyHellen RaffalliImedla MayorDipek RamRebecca KeepingKatie HennessyAmmar KadhimMd Moidul IslamManjunath PrasadCheryl WebsterVicky SlaterSaffnan MohamedSaba Raza KnightTerri-Louise CromieAllan BrownRuth PenningtonCharlene CampbellAnthony GhoshTeresa FitzpatrickMohammed PatelWinnington RuizMirriam TaylorDivina AnyogKatarzyna TluchowskaJackson NolascoKleopatra AngelopoulouBethany WelchIda PonceLucy BaileyMia MarsdenAngelene CopeDeepthy BlessonRachel SuttonMary KambafwileJade McAndrew
Source
BMJ Open, Vol 13, Iss 8 (2023)
Subject
Medicine
Language
English
ISSN
2044-6055
Abstract
Introduction The top research priority for cavernoma, identified by a James Lind Alliance Priority setting partnership was ‘Does treatment (with neurosurgery or stereotactic radiosurgery) or no treatment improve outcome for people diagnosed with a cavernoma?’ This pilot randomised controlled trial (RCT) aims to determine the feasibility of answering this question in a main phase RCT.Methods and analysis We will perform a pilot phase, parallel group, pragmatic RCT involving approximately 60 children or adults with mental capacity, resident in the UK or Ireland, with an unresected symptomatic brain cavernoma. Participants will be randomised by web-based randomisation 1:1 to treatment with medical management and with surgery (neurosurgery or stereotactic radiosurgery) versus medical management alone, stratified by prerandomisation preference for type of surgery. In addition to 13 feasibility outcomes, the primary clinical outcome is symptomatic intracranial haemorrhage or new persistent/progressive focal neurological deficit measured at 6 monthly intervals. An integrated QuinteT Recruitment Intervention (QRI) evaluates screening logs, audio recordings of recruitment discussions, and interviews with recruiters and patients/parents/carers to identify and address barriers to participation. A Patient Advisory Group has codesigned the study and will oversee its progress.Ethics and dissemination This study was approved by the Yorkshire and The Humber—Leeds East Research Ethics Committee (21/YH/0046). We will submit manuscripts to peer-reviewed journals, describing the findings of the QRI and the Cavernomas: A Randomised Evaluation (CARE) pilot trial. We will present at national specialty meetings. We will disseminate a plain English summary of the findings of the CARE pilot trial to participants and public audiences with input from, and acknowledgement of, the Patient Advisory Group.Trial registration number ISRCTN41647111.