Palliative Radiotherapy and Brachytherapy for Oesophageal Cancer Dysphagia

NCT ID: NCT00665197

Last Updated: 2011-10-13

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

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-02-28

Study Completion Date

2011-02-28

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Hypothesis: In the management of advanced oesophageal cancer, to determine if a shorter regime of external beam radiotherapy (using higher daily doses, and combined with intraluminal high dose rate brachytherapy) is not inferior in the palliation of dysphagia than a more protracted course of external beam radiotherapy (using lower daily doses and combined with equal intraluminal high dose rate brachytherapy).

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

This is a prospective, pragmatic and multi-centre clinical trial, without blinding or masking to the randomly assigned treatment. Patient registration and randomization are centralized. There are two arms to the study, expecting an equal numbers of patients randomized to each arm. Stratification will by according to: (1) treating institution/country, and (2) baseline Stage (M1 = distant metastases versus M0 = no distant metastases). The primary statistical analysis will be conducted as an "intention-to-treat" clinical trial.

A cost-effectiveness analysis is not required because the main contrast is between 5 and 10 fractions of EBRT, where 5 fractions are less expensive than 10 fractions. This protocol follows the recommendations of CONSORT for the reporting of non-inferiority and equivalence trials. The active control is 30 Gy in 10 fractions, and the new therapy is 20 Gy in 5 fractions.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Esophageal Cancer

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Protracted Course Radiotherapy

High Dose Rate brachytherapy 8.0 Gy x 2

External beam radiotherapy 30 Gy in 10 fractions of 3.0 Gy

Group Type ACTIVE_COMPARATOR

Protracted Course Radiotherapy

Intervention Type RADIATION

External Beam Radiation 30 Gy in 10 fractions

Short Course Radiotherapy

High Dose Rate brachytherapy 8.0 Gy x 2

External beam radiotherapy 20 Gy in 5 fractions of 4.0 Gy

Group Type EXPERIMENTAL

Short Course Radiotherapy

Intervention Type RADIATION

External Beam Radiation 20 Gy in 5 fractions

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Protracted Course Radiotherapy

External Beam Radiation 30 Gy in 10 fractions

Intervention Type RADIATION

Short Course Radiotherapy

External Beam Radiation 20 Gy in 5 fractions

Intervention Type RADIATION

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Endoscopic and biopsy-proven carcinoma of the esophagus, either Adenocarcinoma or Squamous cell carcinoma;
* Lesions of the thoracic oesophagus and the abdominal oesophagus but not involving the cardia of the stomach. (The oesophagus extends from the cricopharyngeus muscle at the level of the cricoid cartilage to the GEJ junction. The most proximate cervical oesophagus extends approximately 2-3 cm distal to the cricopharyngeus muscle approximately 18 cm from the incisors, and is excluded from this study; however the remaining oesophagus is included in this study, including the last 1-2 cm of the oesophagus which is intra-abdominal and up to the GEJ.);
* Dysphagia immediately prior to the first HDR ILBT session (based on a 4-question summary score of 4-15 (i.e. less than a score of 16) using four of the questions from the EORTC QLQ OES-18 measure;
* Able to insert the intra-esophageal applicator (Dilatation is allowed to open up the tumor/lumen to facilitate insertion, and this does not preclude eligibility. Any oesophageal stent must be removed prior to brachytherapy because metal stents may inappropriately increase the dose of radiation to the esophageal wall by approximately 10%.\]);
* Karnofsky is between 40 and 90, inclusive and at baseline (no patient can be 100 as all will have at least dysphagia from disease at baseline; patients with KPS \<40 are not eligible for this study);
* Eligible for radiotherapy (e.g. any pacemaker is not within 2.5 cm of the outside of the field edge for the EBRT component of therapy);
* Signed informed consent.

Exclusion Criteria

* Age less than 18;
* Patients suitable for curative treatment with either surgery or chemo-radiation;
* Tracheo-esophageal fistula, or deep mucosal ulceration;
* Perforation or massive esophageal bleeding ;
* Stents in situ (i.e. not removed prior to the first HDR ILBT);
* Previous thoracic radiation therapy for any cause, either EBRT or ILBT;
* Evidence of other uncontrolled malignancies, or evidence of synchronous head and neck or lung primary cancers (regardless of whether those malignancies could be managed with curative intent);
* Failure to complete all baseline assessments required for the study, including patient-elicited scores for symptoms and QOL;
* Pregnant or lactating patients.
Minimum Eligible Age

18 Years

Maximum Eligible Age

81 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

International Atomic Energy Agency

OTHER_GOV

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Eduardo Rosenblatt, MD

Role: STUDY_CHAIR

International Atomic Energy Agency

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Credit Valley Hospital Statistical Centre

Credit Valley, Ontario, Canada

Site Status

Chinese Academy of Medical Sciences

Beijing, Beijing Municipality, China

Site Status

University of Zagreb Clinical Hospital

Zagreb, City of Zagreb, Croatia

Site Status

Tata Memorial Hospital

Mumbai, Parel, India

Site Status

Institute of Nuclear Medicine and Oncology

Lahore, Punjab Province, Pakistan

Site Status

University of the Witwatersrand Department of Radiat. Oncology

Johannesburg, Parktown, South Africa

Site Status

Mahidol University Faculty of Medicine Siriraj Hospital

Bangkok, Siriraj, Thailand

Site Status

Countries

Review the countries where the study has at least one active or historical site.

Canada China Croatia India Pakistan South Africa Thailand

References

Explore related publications, articles, or registry entries linked to this study.

Sur RK, Donde B, Levin VC, Mannell A. Fractionated high dose rate intraluminal brachytherapy in palliation of advanced esophageal cancer. Int J Radiat Oncol Biol Phys. 1998 Jan 15;40(2):447-53. doi: 10.1016/s0360-3016(97)00710-4.

Reference Type BACKGROUND
PMID: 9457834 (View on PubMed)

Sur RK, Levin CV, Donde B, Sharma V, Miszczyk L, Nag S. Prospective randomized trial of HDR brachytherapy as a sole modality in palliation of advanced esophageal carcinoma--an International Atomic Energy Agency study. Int J Radiat Oncol Biol Phys. 2002 May 1;53(1):127-33. doi: 10.1016/s0360-3016(02)02702-5.

Reference Type BACKGROUND
PMID: 12007950 (View on PubMed)

Gaspar LE, Nag S, Herskovic A, Mantravadi R, Speiser B. American Brachytherapy Society (ABS) consensus guidelines for brachytherapy of esophageal cancer. Clinical Research Committee, American Brachytherapy Society, Philadelphia, PA. Int J Radiat Oncol Biol Phys. 1997 Apr 1;38(1):127-32. doi: 10.1016/s0360-3016(97)00231-9.

Reference Type BACKGROUND
PMID: 9212013 (View on PubMed)

Kumar MU, Swamy K, Supe SS, Anantha N. Influence of intraluminal brachytherapy dose on complications in the treatment of esophageal cancer. Int J Radiat Oncol Biol Phys. 1993 Dec 1;27(5):1069-72. doi: 10.1016/0360-3016(93)90525-z.

Reference Type BACKGROUND
PMID: 8262829 (View on PubMed)

Related Links

Access external resources that provide additional context or updates about the study.

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

E3.30.27

Identifier Type: -

Identifier Source: org_study_id