Eingeschränkte vs Ausgedehnte Lymphadenektomie LEA

NCT ID: NCT01215071

Last Updated: 2018-01-24

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

NA

Total Enrollment

401 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-02-28

Study Completion Date

2015-08-31

Brief Summary

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This trial evaluates the therapeutic benefit of extended versus limited lymphadenectomy at the time of radical cystectomy in patients with bladder cancer.

Detailed Description

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The extent of pelvic lymphadenectomy in the surgical treatment of muscle-invasive, clinically locally bladder cancer is not yet standardized. There are no data from randomized, prospective studies on the prognostic role of regional lymphadenectomy.

Results of retrospective studies suggest, that the prognosis of patients with muscle-invasive bladder cancer can be improved by extending the limits of pelvic lymphadenectomy. Furthermore it could be demonstrated in a prospective study that the pattern of metastasis of bladder cancer has a high variability. About two-thirds of lymph node metastases are found outside the normally cleared areas of lymphadenectomy. In this study patients will be randomized into arms with limited versus extended lymphadenectomy.

The limited lymphadenectomy includes the removal of the obturatoric, external and internal iliac lymph nodes, the extended one includes the removal of all lymph nodes between pelvic floor and the inferior mesenteric artery. The primary objective of the study is to detemine the influence of limited versus extended lyphadenectomy at the time of radical cystectomy on recurrence-free survival. Secondary study objectives include the influence on cancer-specific survival, overall survival, complication rates, histopathologic N-stage, the localization of recurrence and influence of adjuvant chemotherapy . Adjuvant chemotherapy is optional and is recommended in patients with locally advanced disease (pT3/4) or regional lymph node metastasis (pN+).

Conditions

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Bladder 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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limited lymphadenectomy

Fields 5, 7, 9, 11, 13, 14 are removed

Group Type EXPERIMENTAL

limited lymphadenectomy

Intervention Type PROCEDURE

Field 5 (Group external iliac rigt) Field 7 (Group external iliac left) Field 9 (obturatorical Group right) Field 11 (obturatorical Group left) Field 13 (Group internal iliac right) Field 14 (Group internal iliac left)

extended lymphadenectomy

Fields 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 are removed

Group Type EXPERIMENTAL

extended lymphadenectomy

Intervention Type PROCEDURE

Field 1 (paracaval right) Field 2 (interaortocaval) Field 3 (paraaortal left) Field 4 (Group iliac artery right) Field 5 (Group external iliac rigt) Field 6 (Group iliac artery left) Field 7 (Group external iliac left) Field 8 (presacral) Field 9 (obturatorical Group right) Field 10 (deep obturatorical Group right) Field 11 (obturatorical Group left) Field 12 (deep obturatorical Group left) Field 13 (Group internal iliac right) Field 14 (Group internal iliac left)

Interventions

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limited lymphadenectomy

Field 5 (Group external iliac rigt) Field 7 (Group external iliac left) Field 9 (obturatorical Group right) Field 11 (obturatorical Group left) Field 13 (Group internal iliac right) Field 14 (Group internal iliac left)

Intervention Type PROCEDURE

extended lymphadenectomy

Field 1 (paracaval right) Field 2 (interaortocaval) Field 3 (paraaortal left) Field 4 (Group iliac artery right) Field 5 (Group external iliac rigt) Field 6 (Group iliac artery left) Field 7 (Group external iliac left) Field 8 (presacral) Field 9 (obturatorical Group right) Field 10 (deep obturatorical Group right) Field 11 (obturatorical Group left) Field 12 (deep obturatorical Group left) Field 13 (Group internal iliac right) Field 14 (Group internal iliac left)

Intervention Type PROCEDURE

Other Intervention Names

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eingeschränkte Lymphadenektomie eingeschränkte LA ausgedehnte Lymphadenektomie ausgedehnte LA

Eligibility Criteria

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Inclusion Criteria

* Histologically proven, invasive urothelial bladder cancer, locally completely resectable (T1G3 - T4a, Nx)
* Age \>= 18 years
* Written consent of the patient
* Patient compliance and geographic proximity to allow adequate follow-up

Exclusion Criteria

* Histologically or by imaging diagnostics proven organ metastases
* Radiographic evidence of enlarged lymph nodes (\> 1 cm) above the aortic bifurcation in conjunction with pelvic lymph node metastases
* Radiographic or other evidence of T4b-tumor (infiltration of the pelvic wall or other organ systems)
* Prior neoadjuvant chemotherapy of bladder cancer
* Prior previous pelvic lymphadenectomy
* Prior radiotherapy to the pelvis
* internal medical or anesthetic risk factors that require a short operation time
* Palliative cystectomy (f.e. bulky-disease, infiltration of adjacent structures)
* Evidence of another tumor restricting life expectancy of the patient
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Eli Lilly and Company

INDUSTRY

Sponsor Role collaborator

Association of Urologic Oncology (AUO)

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jürgen E. Gschwend, Prof. Dr.

Role: PRINCIPAL_INVESTIGATOR

AUO - Association of Urologic Oncology

Locations

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University of Cologne

Cologne, , Germany

Site Status

Hospital Holweide

Cologne, , Germany

Site Status

Urological hospital, Städt. Kliniken Dortmund

Dortmund, , Germany

Site Status

Paracelsus Hospital

Düsseldorf, , Germany

Site Status

Heinrich Heine University

Düsseldorf, , Germany

Site Status

University of Essen

Essen, , Germany

Site Status

Department of urology, städt. Klinikum Fulda

Fulda, , Germany

Site Status

Saarland University

Homburg/Saar, , Germany

Site Status

Städt. Klinikum

Karlsruhe, , Germany

Site Status

Urological Hospital Kassel

Kassel, , Germany

Site Status

Klinikum Ludwigshafen

Ludwigshafen, , Germany

Site Status

Otto von Guericke University

Magdeburg, , Germany

Site Status

Klinikum r. d. Isar der TUM

München, , Germany

Site Status

Eberhard Karls University

Tübingen, , Germany

Site Status

Urological hospital, University Hospital Ulm

Ulm, , Germany

Site Status

Helios Klinikum Wuppertal

Wuppertal, , Germany

Site Status

Countries

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Germany

References

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Gschwend JE, Heck MM, Lehmann J, Rubben H, Albers P, Wolff JM, Frohneberg D, de Geeter P, Heidenreich A, Kalble T, Stockle M, Schnoller T, Stenzl A, Muller M, Truss M, Roth S, Liehr UB, Leissner J, Bregenzer T, Retz M. Extended Versus Limited Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Survival Results from a Prospective, Randomized Trial. Eur Urol. 2019 Apr;75(4):604-611. doi: 10.1016/j.eururo.2018.09.047. Epub 2018 Oct 15.

Reference Type DERIVED
PMID: 30337060 (View on PubMed)

Froehner M, Novotny V, Heberling U, Rutsch L, Litz RJ, Hubler M, Koch R, Baretton GB, Wirth MP. Relationship of the number of removed lymph nodes to bladder cancer and competing mortality after radical cystectomy. Eur Urol. 2014 Dec;66(6):987-90. doi: 10.1016/j.eururo.2014.07.046. Epub 2014 Aug 19.

Reference Type DERIVED
PMID: 25150172 (View on PubMed)

Related Links

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http://www.auo-online.de

The AUO Homepage where this study is presented

Other Identifiers

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AB 25/02

Identifier Type: -

Identifier Source: org_study_id

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