Lymph Node Removal in Treating Patients With Stage I or Stage II Non-small Cell Lung Cancer

NCT ID: NCT00003831

Last Updated: 2016-07-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

1023 participants

Study Classification

INTERVENTIONAL

Study Start Date

1999-07-31

Study Completion Date

2011-01-31

Brief Summary

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RATIONALE: Surgical removal of all lymph nodes in the chest may kill cancer cells that have spread from tumors in the lung. It is not yet known whether complete removal of all lymph nodes in the chest is more effective than removal of selected lymph nodes in treating patients who have stage I or stage II non-small cell lung cancer.

PURPOSE: Randomized phase III trial to compare the effectiveness of complete removal of all lymph nodes in the chest with that of selected removal of lymph nodes during lung cancer surgery in treating patients who have stage I or stage II non-small cell lung cancer.

Detailed Description

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OBJECTIVES:

* Compare whether a complete mediastinal lymph node dissection versus mediastinal lymph node sampling improves overall survival of patients with N0 or non-hilar N1 non-small cell lung cancer undergoing resection.
* Compare these two methods with reference to identification of occult mediastinal lymph node involvement.
* Compare the effect of these two methods on operative time and duration of postoperative complications, including chest tube drainage and length of hospitalization for these patients.
* Compare the effect of these two methods on local recurrence free survival and local regional recurrence free survival of these patients.

Conditions

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Lung Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Lymph node sampling

Patients undergo pulmonary resection. No additional lymph nodes are removed. Patients are followed at 4, 6, 8, 12, 18, 24, and 36 months and then annually thereafter until death.

Group Type EXPERIMENTAL

conventional surgery

Intervention Type PROCEDURE

Lymph node dissection

Patients undergo removal of nearly all of the lymph nodes from the central part of the chest between the lungs, followed by pulmonary resection. Patients are followed at 4, 6, 8, 12, 18, 24, and 36 months and then annually thereafter until death.

Group Type ACTIVE_COMPARATOR

conventional surgery

Intervention Type PROCEDURE

Interventions

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conventional surgery

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

A patient will be eligible for inclusion in this study only if ALL of the following criteria apply:

Pre-operative:

1. Patient must be ≥18 years of age.
2. Patient must have an ECOG/Zubrod performance status of ≤ 3.
3. Patient must have tissue diagnosis of a clinically resectable T1 or T2, N0 or non-hilar N1, M0 NSCLC (squamous cell carcinoma, large cell carcinoma or adenocarcinoma including bronchoalveolar carcinoma) established prior to randomization. NOTE: A patient without a pre-operative tissue diagnosis, but with clinically suspected NSCLC that fits the above criteria is eligible provided the tissue diagnosis is confirmed intraoperatively.
4. Patient must have pre-operative imaging procedure, CT scan of the chest and upper abdomen to include liver and adrenal glands to determine eligibility, within 60 days of the date of the pulmonary resection.
5. Patient that has not had a mediastinoscopy should have no mediastinal adenopathy on the CT of the chest defined as no lymph node \> 1 cm in the shortest axis.
6. Patient is a candidate for a complete resection of the carcinoma via pneumonectomy,lobectomy, bilobectomy, or anatomic segmentectomy with or without sleeve resection,as noted in the surgical plan.
7. Patient, or patient's legally acceptable representative, must provide a signed and dated Z0030-specific written informed consent prior to registration and any study-related procedures.
8. If patient is a survivor of a prior cancer, the following criteria are met:

1. Patient has undergone potentially curative therapy for all prior malignancies,
2. No evidence of any prior malignancies for at least 5 years with no evidence of recurrence (except for effectively treated basal cell or squamous carcinoma of the skin, carcinoma in-situ of the cervix that has been effectively treated by surgery alone, or lobular carcinoma in-situ of the ipsilateral or contralateral breast treated by surgery alone),
3. Patient is deemed by their treating physician to be at low risk for recurrence from prior malignancies.

Intra-operative:

1. Patient with right-sided lesions must have at least nodal stations #2R, 4R, 7 and 10 R examined. If the nodes are found, they must be sampled and proven negative by frozen section.
2. Patient with left-sided lesions must have at least nodal stations #5, 6, 7 and 10L examined. If the nodes are found, they must be sampled and proven negative by frozen section.
3. Any other suspicious mediastinal or hilar nodes must be sampled and proven negative by frozen section. Levels 2, 4 and 7 need not be re-sampled if they were sampled at a mediastinoscopy done within 60 days of thehoracotomy.

Exclusion Criteria

A patient will NOT be eligible for inclusion in this study if ANY of the following criteria apply:

1. Patient has N2 disease determined at pre-operative mediastinoscopy or on sampling.
2. Patient has T3 or T4 tumor.
3. Patient is having only a wedge resection performed for treatment.
4. Patient has received prior chemotherapy or radiotherapy for this cancer.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Alliance for Clinical Trials in Oncology

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mark S. Allen, MD

Role: STUDY_CHAIR

Mayo Clinic

Locations

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Mobile Infirmary Medical Center

Mobile, Alabama, United States

Site Status

Cedars-Sinai Comprehensive Cancer Center at Cedars-Sinai Medical Center

Los Angeles, California, United States

Site Status

Chao Family Comprehensive Cancer Center at University of California Irvine Cancer Center

Orange, California, United States

Site Status

Huntington Cancer Center at Huntington Hospital

Pasadena, California, United States

Site Status

UCSF Comprehensive Cancer Center

San Francisco, California, United States

Site Status

Stanford University Medical Center

Stanford, California, United States

Site Status

Veterans Affairs Medical Center - Gainesville

Gainesville, Florida, United States

Site Status

Shands Cancer Center at the University of Florida

Gainesville, Florida, United States

Site Status

Holmes Regional Medical Center

Melbourne, Florida, United States

Site Status

Jackson Memorial Hospital

Miami, Florida, United States

Site Status

Emory University School of Medicine

Atlanta, Georgia, United States

Site Status

Medical Center of Central Georgia

Macon, Georgia, United States

Site Status

University of Chicago Cancer Research Center

Chicago, Illinois, United States

Site Status

Alexian Brothers Medical Center

Elk Grove Village, Illinois, United States

Site Status

Loyola University Medical Center

Maywood, Illinois, United States

Site Status

Edward Hospital Cancer Center

Naperville, Illinois, United States

Site Status

St. John's Hospital

Springfield, Illinois, United States

Site Status

Southern Illinois University School of Medicine

Springfield, Illinois, United States

Site Status

Central Baptist Hospital

Lexington, Kentucky, United States

Site Status

Jewish Hospital

Louisville, Kentucky, United States

Site Status

Medical Center of Southwest Louisiana

Lafayette, Louisiana, United States

Site Status

Massachusetts General Hospital Cancer Center

Boston, Massachusetts, United States

Site Status

Rhode Island Hospital

Boston, Massachusetts, United States

Site Status

Beth Israel Deaconess Medical Center

Boston, Massachusetts, United States

Site Status

Hurley Medical Center

Flint, Michigan, United States

Site Status

William Beaumont Hospital - Royal Oak

Royal Oak, Michigan, United States

Site Status

St. Luke's Hospital

Duluth, Minnesota, United States

Site Status

Veterans Affairs Medical Center - Minneapolis

Minneapolis, Minnesota, United States

Site Status

Mayo Clinic Cancer Center

Rochester, Minnesota, United States

Site Status

Ellis Fischel Cancer Center at University of Missouri - Columbia

Columbia, Missouri, United States

Site Status

Barnes-Jewish Hospital

St Louis, Missouri, United States

Site Status

Veterans Affairs Medical Center - Omaha

Omaha, Nebraska, United States

Site Status

Creighton University School of Medicine

Omaha, Nebraska, United States

Site Status

Englewood Hospital Oncology Program

Englewood, New Jersey, United States

Site Status

Valley Hospital

Ridgewood, New Jersey, United States

Site Status

Roswell Park Cancer Institute

Buffalo, New York, United States

Site Status

Louis Busch Hager Cancer Center at Mary Imogene Bassett Hospital

Cooperstown, New York, United States

Site Status

Memorial Sloan-Kettering Cancer Center

New York, New York, United States

Site Status

New York Weill Cornell Cancer Center at Cornell University

New York, New York, United States

Site Status

James P. Wilmot Cancer Center at University of Rochester Medical Center

Rochester, New York, United States

Site Status

Long Island Cancer Center at Stony Brook University Hospital

Stony Brook, New York, United States

Site Status

Trinity Hospital

Minot, North Dakota, United States

Site Status

Veterans Affairs Medical Center - Cincinnati

Cincinnati, Ohio, United States

Site Status

Tri-Health Good Samaritan Hospital

Cincinnati, Ohio, United States

Site Status

Charles M. Barrett Cancer Center at University Hospital

Cincinnati, Ohio, United States

Site Status

Ireland Cancer Center

Cleveland, Ohio, United States

Site Status

Earle A. Chiles Research Institute at Providence Portland Medical Center

Portland, Oregon, United States

Site Status

Westmoreland Regional Hospital

Greensburg, Pennsylvania, United States

Site Status

Jameson Memorial Hospital

New Castle, Pennsylvania, United States

Site Status

Abramson Cancer Center at University of Pennsylvania Medical Center

Philadelphia, Pennsylvania, United States

Site Status

Kimmel Cancer Center at Thomas Jefferson University - Philadelphia

Philadelphia, Pennsylvania, United States

Site Status

Fox Chase Cancer Center

Philadelphia, Pennsylvania, United States

Site Status

Temple University Hospital

Philadelphia, Pennsylvania, United States

Site Status

Allegheny General Hospital

Pittsburgh, Pennsylvania, United States

Site Status

University of Pittsburg Medical Center - Shadyside Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Presbyterian-University Hospital

Pittsburgh, Pennsylvania, United States

Site Status

UPMC St. Margaret

Pittsburgh, Pennsylvania, United States

Site Status

Western Pennsylvania Hospital

Pittsburgh, Pennsylvania, United States

Site Status

St. Clair Memorial Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Lankenau Cancer Center at Lankenau Hospital

Wynnewood, Pennsylvania, United States

Site Status

Saint Thomas Hospital

Nashville, Tennessee, United States

Site Status

University of Texas - MD Anderson Cancer Center

Houston, Texas, United States

Site Status

LDS Hospital

Salt Lake City, Utah, United States

Site Status

Cancer Center at the University of Virginia

Charlottesville, Virginia, United States

Site Status

Massey Cancer Center

Richmond, Virginia, United States

Site Status

Swedish Cancer Institute at Swedish Medical Center - First Hill Campus

Seattle, Washington, United States

Site Status

University of Washington Medical Center

Seattle, Washington, United States

Site Status

Veterans Affairs Medical Center - Seattle

Seattle, Washington, United States

Site Status

West Virginia University Hospitals

Morgantown, West Virginia, United States

Site Status

University of Wisconsin Comprehensive Cancer Center

Madison, Wisconsin, United States

Site Status

Peter MacCallum Cancer Centre

East Melbourne, Victoria, Australia

Site Status

St. Vincent's Hospital

Fitzroy, Victoria, Australia

Site Status

Cancer Care Ontario-London Regional Cancer Centre

London, Ontario, Canada

Site Status

Toronto General Hospital

Toronto, Ontario, Canada

Site Status

Countries

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United States Australia Canada

References

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Potti A, Mukherjee S, Petersen R, Dressman HK, Bild A, Koontz J, Kratzke R, Watson MA, Kelley M, Ginsburg GS, West M, Harpole DH Jr, Nevins JR. A genomic strategy to refine prognosis in early-stage non-small-cell lung cancer. N Engl J Med. 2006 Aug 10;355(6):570-80. doi: 10.1056/NEJMoa060467.

Reference Type BACKGROUND
PMID: 16899777 (View on PubMed)

Fibla JJ, Cassivi SD, Brunelli A, Decker PA, Allen MS, Darling GE, Landreneau RJ, Putnam JB. Re-evaluation of the prognostic value of visceral pleura invasion in Stage IB non-small cell lung cancer using the prospective multicenter ACOSOG Z0030 trial data set. Lung Cancer. 2012 Dec;78(3):259-62. doi: 10.1016/j.lungcan.2012.09.010. Epub 2012 Oct 3.

Reference Type RESULT
PMID: 23040416 (View on PubMed)

Darling GE, Allen MS, Decker PA, Ballman K, Malthaner RA, Inculet RI, Jones DR, McKenna RJ, Landreneau RJ, Putnam JB Jr. Number of lymph nodes harvested from a mediastinal lymphadenectomy: results of the randomized, prospective American College of Surgeons Oncology Group Z0030 trial. Chest. 2011 May;139(5):1124-1129. doi: 10.1378/chest.10-0859. Epub 2010 Sep 9.

Reference Type RESULT
PMID: 20829340 (View on PubMed)

Darling GE, Allen MS, Decker PA, Ballman K, Malthaner RA, Inculet RI, Jones DR, McKenna RJ, Landreneau RJ, Rusch VW, Putnam JB Jr. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg. 2011 Mar;141(3):662-70. doi: 10.1016/j.jtcvs.2010.11.008.

Reference Type RESULT
PMID: 21335122 (View on PubMed)

Allen MS, Darling GE, Pechet TT, Mitchell JD, Herndon JE 2nd, Landreneau RJ, Inculet RI, Jones DR, Meyers BF, Harpole DH, Putnam JB Jr, Rusch VW; ACOSOG Z0030 Study Group. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006 Mar;81(3):1013-9; discussion 1019-20. doi: 10.1016/j.athoracsur.2005.06.066.

Reference Type RESULT
PMID: 16488712 (View on PubMed)

Other Identifiers

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CDR0000066988

Identifier Type: REGISTRY

Identifier Source: secondary_id

ACOSOG-Z0030

Identifier Type: -

Identifier Source: org_study_id

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