Surgery With or Without Radiation Therapy and Chemotherapy in Treating Patients With Esophageal Cancer

NCT ID: NCT00047112

Last Updated: 2020-03-30

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

195 participants

Study Classification

INTERVENTIONAL

Study Start Date

2002-05-31

Study Completion Date

2010-09-30

Brief Summary

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RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving combination chemotherapy with radiation therapy before surgery may shrink the tumor so it can be removed during surgery. It is not yet known if surgery is more effective with or without radiation therapy and chemotherapy in treating esophageal cancer.

PURPOSE: Randomized phase III trial to compare the effectiveness of surgery with or without radiation therapy and chemotherapy in treating patients who have esophageal cancer.

Detailed Description

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OBJECTIVES:

* Compare the overall survival of patients with resectable thoracic esophageal cancer treated with neoadjuvant radio-chemotherapy and surgery versus surgery alone.
* Compare the disease-free survival of patients treated with these regimens.
* Compare the surgical mortality and morbidity of patients treated with these regimens.
* Compare the resectability of patients treated with these regimens.
* Determine the validation of new prognostic factors for survival of these patients and/or the efficacy of this neoadjuvant treatment.

OUTLINE: This is a randomized, open-label, multicenter study. Patients are stratified according to histology (epidermoid carcinoma vs adenocarcinoma vs undifferentiated carcinoma), stage (I vs IIA vs IIB), tumor location (above the carina vs below the carina), and participating center. Patients are randomized to 1 of 2 treatment arms.

* Arm I: Patients undergo radiotherapy daily 5 days a week for 5 weeks. Patients receive fluorouracil IV continuously on days 1-4 and 29-32 and cisplatin IV on days 1 or 2 and 29 or 30 (or a lower dose on days 1-5 and 29-33). Within 4-8 weeks after completion of radio-chemotherapy, patients undergo surgical resection.
* Arm II: Patients undergo surgical resection. Patients are followed every 4 months for 2 years, every 6 months for 3 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 380 patients (190 per treatment arm) will be accrued for this study within 3 years.

Conditions

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Esophageal 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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CHIMIORADIOTHERAPIE SUIVIE DE CHIRURGIE

CHIMIORADIOTHERAPIE SUIVIE DE CHIRURGIE

Group Type EXPERIMENTAL

cisplatin

Intervention Type DRUG

fluorouracil

Intervention Type DRUG

conventional surgery

Intervention Type PROCEDURE

neoadjuvant therapy

Intervention Type PROCEDURE

radiation therapy

Intervention Type RADIATION

CHIRURGIE SEULE

CHIRURGIE SEULE

Group Type ACTIVE_COMPARATOR

conventional surgery

Intervention Type PROCEDURE

Interventions

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cisplatin

Intervention Type DRUG

fluorouracil

Intervention Type DRUG

conventional surgery

Intervention Type PROCEDURE

neoadjuvant therapy

Intervention Type PROCEDURE

radiation therapy

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

DISEASE CHARACTERISTICS:

* Diagnosis of stage I or II thoracic esophageal cancer

* Tumor no greater than 3 cm with no invasion of mediastinal structures with or without extension to the lymph nodes (T1-2, N0-1, M0) OR
* Tumor greater than 3 cm with no invasion of mediastinal structures and no adenopathy greater than 1 cm (T3, N0, M0)
* Epidermoid carcinoma or adenocarcinoma
* Previously untreated
* Deemed resectable with curative intent
* No carcinoma in situ
* No small cell anaplastic carcinoma (i.e., chromogranin negative)
* No small cell neuroendocrine carcinoma (i.e., chromogranin positive)
* No multifocal esophageal carcinoma (i.e., 2 or more distinct lesions 5 or more cm apart)
* No involvement of the pharyngoesophageal junction and the first 4 cm of the esophagus (i.e., where the proximal edge of the tumor is less than 19 cm from the dental arch)
* No evidence of extension to the tracheobronchial tree at endoscopy, ultrasound, or CT scan (simple compression allowed)
* No signs of mediastinal involvement on CT scan
* No palpable subclavicular lymph nodes or involvement after cytology needle aspiration
* No lymph nodes from the origin of the celiac greater than 1 cm on CT scan

* Perigastric lymph nodes far from the celiac trunk and deemed resectable allowed unless tumor is more than 30 mm on CT scan

PATIENT CHARACTERISTICS:

Age

* Under 75

Performance status

* WHO 0-1

Life expectancy

* Not specified

Hematopoietic

* Granulocyte count at least 1,500/mm\^3
* Platelet count at least 100,000/mm\^3

Hepatic

* SGOT/SGPT ratio no greater than 1
* Albumin at least 35 g/L
* Total protein greater than 80%
* No liver cirrhosis with previous failure
* No ascites
* No jaundice
* No rupture of varicose esophageal veins
* No presence of varicose esophageal veins

Renal

* Creatinine no greater than 1.25 times normal

Cardiovascular

* Arterial O\_2 greater than 60 mm Hg
* Arterial CO\_2 no greater than 45 mm Hg
* No myocardial infarction within the past 6 months
* No progressive coronary artery disease grade 2 or greater
* No recent left ventricular failure
* No arterial disease stage II-IV

Pulmonary

* FEV\_1 greater than 1 L/sec

Other

* Able to receive either study treatment
* No recurrent paralysis
* No weight loss greater than 10% from baseline
* No other prior or concurrent malignancy except basal cell skin cancer or carcinoma in situ of the cervix
* Not pregnant
* Fertile patients must use effective contraception during and for 3 months after completion of chemotherapy

PRIOR CONCURRENT THERAPY:

Biologic therapy

* Not specified

Chemotherapy

* Not specified

Endocrine therapy

* Not specified

Radiotherapy

* Not specified

Surgery

* Not specified
Maximum Eligible Age

74 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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GERCOR - Multidisciplinary Oncology Cooperative Group

OTHER

Sponsor Role collaborator

European Organisation for Research and Treatment of Cancer - EORTC

NETWORK

Sponsor Role collaborator

UNICANCER

OTHER

Sponsor Role collaborator

Societe Francaise de Radiotherapie Oncologique

OTHER

Sponsor Role collaborator

Federation Francophone de Cancerologie Digestive

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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J. P. Triboulet

Role: STUDY_CHAIR

Centre Hospitalier Regional et Universitaire de Lille

Jean-Francois Seitz, MD

Role: STUDY_CHAIR

Institut Paoli-Calmettes

Locations

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Institut Jules Bordet

Brussels, , Belgium

Site Status

Hopital Universitaire Erasme

Brussels, , Belgium

Site Status

Universitair Ziekenhuis Antwerpen

Edegem, , Belgium

Site Status

Universiteit Gent

Ghent, , Belgium

Site Status

CHR - Clinique Saint Joseph - Hopital de Warqueguies

Mons, , Belgium

Site Status

Centre Hospitalier Regional et Universitaire d'Angers

Angers, , France

Site Status

Centre Paul Papin

Angers, , France

Site Status

Arras, , France

Site Status

CHR de Besancon - Hopital Jean Minjoz

Besançon, , France

Site Status

CHU Ambroise Pare

Boulogne-Billancourt, , France

Site Status

Centre Hospitalier Docteur Duchenne

Boulogne-sur-Mer, , France

Site Status

C.H. Bourg En Bresse

Bourg-en-Bresse, , France

Site Status

Centre Hospitalier de Bourgoin - Jallieu

Bourgoin, , France

Site Status

CHU Brest - Hopital De La Cavale Blanche

Brest, , France

Site Status

Centre Hospitalier General

Brivé, , France

Site Status

CHU de Caen

Caen, , France

Site Status

Clinique Sainte Marie

Chalon-sur-Saône, , France

Site Status

CHR Clermont Ferrand, Hotel dieu

Clermont-Ferrand, , France

Site Status

Hopital Beaujon

Clichy, , France

Site Status

Hopital Louis Pasteur

Colmar, , France

Site Status

Centre Hospitalier de Lagny

Compiègne, , France

Site Status

Centre Hospitalier Universitaire de Dijon

Dijon, , France

Site Status

Centre Hospitalier De Dunkerque - CHD

Dunkirk, , France

Site Status

Évreux, , France

Site Status

Centre Hospitalier Departemental

La Roche-sur-Yon, , France

Site Status

Hopital Andre Mignot

Le Chesnay, , France

Site Status

Centre Jean Bernard

Le Mans, , France

Site Status

Hopital Robert Boulin

Libourne, , France

Site Status

Polyclinique Du Bois

Lille, , France

Site Status

Centre Oscar Lambret

Lille, , France

Site Status

Centre Hospitalier Regional et Universitaire de Lille

Lille, , France

Site Status

Hopital de la Croix Rousse

Lyon, , France

Site Status

Institut J. Paoli and I. Calmettes

Marseille, , France

Site Status

Assistance Publique Hopitaux de Marseille Hopitaux Sud

Marseille, , France

Site Status

CHU de la Timone

Marseille, , France

Site Status

Centre Gray

Maubeuge, , France

Site Status

Centre Hospitalier de Meaux

Meaux, , France

Site Status

Hopital Notre-Dame de Bon Secours

Metz, , France

Site Status

CH Meulan

Meulan-en-Yvelines, , France

Site Status

Centre Regional de Lutte Contre le Cancer - Centre Val d'Aurelle

Montpellier, , France

Site Status

Centre Hospitalier

Mulhouse, , France

Site Status

CHR Hotel Dieu

Nantes, , France

Site Status

Hopital de l'Archet

Nice, , France

Site Status

CHR D'Orleans - Hopital de la Source

Orléans, , France

Site Status

Hopital Saint Antoine

Paris, , France

Site Status

Hopital Europeen Georges Pompidou

Paris, , France

Site Status

Centre Hospitalier Lyon Sud

Pierre-Bénite, , France

Site Status

Hopital Jean Bernard

Poitiers, , France

Site Status

Centre Hospitalier De Pontivy

Pontivy, , France

Site Status

Institut Jean Godinot

Reims, , France

Site Status

Centre Hospitalier Universitaire

Reims, , France

Site Status

Centre Eugene Marquis

Rennes, , France

Site Status

Centre Rene Huguenin

Saint-Cloud, , France

Site Status

Centre Hospitalier D'Agen

Saint-Esprit, , France

Site Status

Centre Hospitalier Intercommunal de Poissy

Saint-Germain-en-Laye, , France

Site Status

Centre Joliot Curie Des Docteurs Jean-Christophe Chardon Jacques Hernandez Et Laurent Gasnault

Saint-Martin-Boulogne, , France

Site Status

Clinique Sainte Clotilde

Sainte-Clotilde, , France

Site Status

C.H. Senlis

Senlis, , France

Site Status

Centre Hospitalier General De Saint-Malo

St-Malo, , France

Site Status

Centre Paul Strauss

Strasbourg, , France

Site Status

Hopitaux Universitaire de Strasbourg

Strasbourg, , France

Site Status

Hopital Universitaire Hautepierre

Strasbourg, , France

Site Status

CHU de Tours

Tours, , France

Site Status

Nouvelle Clinique Generale

Valence, , France

Site Status

Centre Hospitalier de Valenciennes

Valenciennes, , France

Site Status

CHU de Nancy - Hopitaux de Brabois

Vandœuvre-lès-Nancy, , France

Site Status

Centre d'Oncologie Saint-Yves

Vannes, , France

Site Status

Institut Gustave Roussy

Villejuif, , France

Site Status

Robert Roessle Comprehensive Cancer Center at University of Berlin - Charite Campus Buch

Berlin, , Germany

Site Status

Universitaet Erlangen

Erlangen, , Germany

Site Status

Klinikum der Albert - Ludwigs - Universitaet Freiburg

Freiburg im Breisgau, , Germany

Site Status

Universitaets-Krankenhaus Eppendorf

Hamburg, , Germany

Site Status

Academisch Ziekenhuis Maastricht

Maastricht, , Netherlands

Site Status

Countries

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Belgium France Germany Netherlands

References

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Mariette C, Robb WB, Piessen G. Reply to Letter: "The Role of Surgery for Patients With a Complete Clinical Response After Chemoradiation for Esophageal Cancer". Ann Surg. 2015 Dec;262(6):e101-2. doi: 10.1097/SLA.0000000000000668. No abstract available.

Reference Type BACKGROUND
PMID: 24670853 (View on PubMed)

Mariette C, Dahan L, Mornex F, Maillard E, Thomas PA, Meunier B, Boige V, Pezet D, Robb WB, Le Brun-Ly V, Bosset JF, Mabrut JY, Triboulet JP, Bedenne L, Seitz JF. Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol. 2014 Aug 10;32(23):2416-22. doi: 10.1200/JCO.2013.53.6532. Epub 2014 Jun 30.

Reference Type RESULT
PMID: 24982463 (View on PubMed)

Robb WB, Dahan L, Mornex F, Maillard E, Thomas PA, Meunier B, Boige V, Pezet D, Le Brun-Ly V, Bosset JF, Mabrut JY, Triboulet JP, Bedenne L, Seitz JF, Mariette C; Federation Francaise de Cancerologie Digestive, Societe Francaise de Radiotherapie Oncologique, Union des Centres de Lutte Contre le Cancer, Groupe Cooperateur Multidisciplinaire en Oncologie, French EsoGAstric Tumour working group, Federation de Recherche En Chirurgie. Impact of neoadjuvant chemoradiation on lymph node status in esophageal cancer: post hoc analysis of a randomized controlled trial. Ann Surg. 2015 May;261(5):902-8. doi: 10.1097/SLA.0000000000000991.

Reference Type RESULT
PMID: 25361220 (View on PubMed)

Robb WB, Messager M, Dahan L, Mornex F, Maillard E, D'Journo XB, Triboulet JP, Bedenne L, Seitz JF, Mariette C; Federation Francophone de Cancerologie Digestive; Societe Francaise de Radiotherapie Oncologique; Union des Centres de Lutte Contre le Cancer; Groupe Cooperateur Multidisciplinaire en Oncologie; French EsoGAstric Tumour working group - Federation de Recherche En Chirurgie. Patterns of recurrence in early-stage oesophageal cancer after chemoradiotherapy and surgery compared with surgery alone. Br J Surg. 2016 Jan;103(1):117-25. doi: 10.1002/bjs.9959. Epub 2015 Oct 29.

Reference Type DERIVED
PMID: 26511668 (View on PubMed)

Other Identifiers

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FFCD-9901

Identifier Type: -

Identifier Source: secondary_id

EORTC-22001

Identifier Type: -

Identifier Source: secondary_id

EORTC-40001

Identifier Type: -

Identifier Source: secondary_id

FRE-FNCLCC-FFCD-9901

Identifier Type: -

Identifier Source: secondary_id

FRE-GERCOR-FFCD-9901

Identifier Type: -

Identifier Source: secondary_id

SFRO-FFCD-9901

Identifier Type: -

Identifier Source: secondary_id

EU-20215

Identifier Type: -

Identifier Source: secondary_id

CDR0000257600

Identifier Type: -

Identifier Source: org_study_id

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