S1011 Standard or Extended Pelvic Lymphadenectomy in Treating Patients Undergoing Surgery for Invasive Bladder Cancer

NCT ID: NCT01224665

Last Updated: 2024-11-29

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

658 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-11-25

Study Completion Date

2024-05-31

Brief Summary

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RATIONALE: Lymphadenectomy may remove tumor cells that have spread to nearby lymph nodes in patients with invasive bladder cancer. It is not yet known whether extended pelvic lymphadenectomy is more effective than standard pelvic lymphadenectomy during surgery.

PURPOSE: This randomized phase II trial is studying standard pelvic lymphadenectomy to see how well it works compared to extended pelvic lymphadenectomy in treating patients undergoing surgery for invasive bladder cancer.

Detailed Description

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OBJECTIVES:

Primary

* To compare disease-free survival (DFS) of patients with muscle-invasive urothelial carcinoma of the bladder undergoing radical cystectomy with extended pelvic lymph node dissection (PLND) or standard pelvic lymphadenectomy.

Secondary

* To compare overall survival (OS) of patients randomized to extended PLND versus those randomized to standard pelvic lymphadenectomy.
* To evaluate operative time; whether or not nerve sparing was performed, intraoperative, peri-operative and 90-day morbidity and mortality; length of hospital stay; histology (pure urothelial versus mixed); lymph node counts and lymph node density; adjuvant chemotherapy received; and local and retroperitoneal soft tissue recurrence in patients randomized to extended PLND versus those randomized to standard pelvic lymphadenectomy.
* To collect peripheral blood and two paraffin-embedded blocks of the primary tumor for translational medicine studies, including circulating tumor cells (CTCs) and markers of epithelial and mesenchymal transition, and correlate these findings with pathologic T stage and node metastasis as well as DFS and OS.

OUTLINE: This is a multicenter study. Patients are stratified according to prior neoadjuvant therapy (yes vs no), clinical stage (T2 vs T3 vs T4a), and Zubrod performance status (0-1 vs 2). Patients are randomized to 1 of 2 treatment arms.

* Arm I: Patients undergo radical cystectomy and standard pelvic lymphadenectomy.
* Arm II: Patients undergo radical cystectomy and extended pelvic lymphadenectomy.

Blood and tumor specimens may be collected periodically for translational studies.

After completion of study therapy, patients are followed up periodically for 6 years.

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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Arm I

therapeutic conventional surgery therapeutic standard lymphadenectomy

Group Type ACTIVE_COMPARATOR

therapeutic conventional surgery

Intervention Type PROCEDURE

Patients undergo radical cystectomy

therapeutic standard lymphadenectomy

Intervention Type PROCEDURE

Patients undergo standard pelvic lymphadenectomy.

Arm II

therapeutic conventional surgery therapeutic extended lymphadenectomy

Group Type EXPERIMENTAL

therapeutic conventional surgery

Intervention Type PROCEDURE

Patients undergo radical cystectomy

therapeutic extended lymphadenectomy

Intervention Type PROCEDURE

Patients undergo extended pelvic lymphadenectomy

Interventions

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therapeutic conventional surgery

Patients undergo radical cystectomy

Intervention Type PROCEDURE

therapeutic standard lymphadenectomy

Patients undergo standard pelvic lymphadenectomy.

Intervention Type PROCEDURE

therapeutic extended lymphadenectomy

Patients undergo extended pelvic lymphadenectomy

Intervention Type PROCEDURE

Eligibility Criteria

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Exclusion Criteria

PRIOR CONCURRENT THERAPY:

* See Disease Characteristics
* No prior partial cystectomy for invasive bladder cancer
* No prior pelvic surgery that would obviate a complete extended lymphadenectomy (e.g., aorto-femoral/iliac bypass)
* Prior neoadjuvant chemotherapy for this cancer allowed provided it has been completed and patient has recovered
* No prior pelvic irradiation
Minimum Eligible Age

18 Years

Maximum Eligible Age

120 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

SWOG Cancer Research Network

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Seth P. Lerner, MD

Role: PRINCIPAL_INVESTIGATOR

Baylor College of Medicine

Locations

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Los Angeles County-USC Medical Center

Los Angeles, California, United States

Site Status

USC / Norris Comprehensive Cancer Center

Los Angeles, California, United States

Site Status

Stanford Cancer Institute

Palo Alto, California, United States

Site Status

University of California Davis Comprehensive Cancer Center

Sacramento, California, United States

Site Status

UCSF Medical Center-Mount Zion

San Francisco, California, United States

Site Status

UCSF Medical Center-Mission Bay

San Francisco, California, United States

Site Status

University of Colorado Cancer Center - Anschutz Cancer Pavilion

Aurora, Colorado, United States

Site Status

Yale University

New Haven, Connecticut, United States

Site Status

Moffitt Cancer Center

Tampa, Florida, United States

Site Status

University of Chicago Comprehensive Cancer Center

Chicago, Illinois, United States

Site Status

Loyola University Medical Center

Maywood, Illinois, United States

Site Status

Louisiana State University Health Sciences Center Shreveport

Shreveport, Louisiana, United States

Site Status

Johns Hopkins University/Sidney Kimmel Cancer Center

Baltimore, Maryland, United States

Site Status

Brigham and Women's Hospital

Boston, Massachusetts, United States

Site Status

Mayo Clinic

Rochester, Minnesota, United States

Site Status

Washington University School of Medicine

St Louis, Missouri, United States

Site Status

Memorial Sloan-Kettering Cancer Center

New York, New York, United States

Site Status

University of Rochester

Rochester, New York, United States

Site Status

Cleveland Clinic Foundation

Cleveland, Ohio, United States

Site Status

Ohio State University Comprehensive Cancer Center

Columbus, Ohio, United States

Site Status

Oregon Health and Science University

Portland, Oregon, United States

Site Status

Portland Veterans Administration Medical Center

Portland, Oregon, United States

Site Status

Parkland Memorial Hospital

Dallas, Texas, United States

Site Status

UT Southwestern/Simmons Cancer Center-Dallas

Dallas, Texas, United States

Site Status

Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center

Houston, Texas, United States

Site Status

Baylor Saint Luke's Medical Center

Houston, Texas, United States

Site Status

M D Anderson Cancer Center

Houston, Texas, United States

Site Status

Audie L Murphy Veterans Affairs Hospital

San Antonio, Texas, United States

Site Status

University of Texas Health Science Center at San Antonio

San Antonio, Texas, United States

Site Status

BCCA-Vancouver Cancer Centre

Vancouver, British Columbia, Canada

Site Status

QEII Health Sciences Centre/Capital District Health Authority

Halifax, Nova Scotia, Canada

Site Status

London Regional Cancer Program

London, Ontario, Canada

Site Status

University Health Network-Princess Margaret Hospital

Toronto, Ontario, Canada

Site Status

McGill University Department of Oncology

Montreal, Quebec, Canada

Site Status

The Research Institute of the McGill University Health Centre (MUHC)

Montreal, Quebec, Canada

Site Status

Countries

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United States Canada

References

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Lerner SP, Tangen C, Svatek RS, Daneshmand S, Pohar KS, Skinner E, Schuckman A, Sagalowsky AI, Smith ND, Kamat AM, Kassouf W, Plets M, Bangs R, Koppie TM, Alva A, La Rosa FG, Pal SK, Kibel AS, Canter DJ, Thompson IM Jr; SWOG S1011 Trial Investigators. Standard or Extended Lymphadenectomy for Muscle-Invasive Bladder Cancer. N Engl J Med. 2024 Oct 3;391(13):1206-1216. doi: 10.1056/NEJMoa2401497.

Reference Type DERIVED
PMID: 39589370 (View on PubMed)

Kamat AM, Hahn NM, Efstathiou JA, Lerner SP, Malmstrom PU, Choi W, Guo CC, Lotan Y, Kassouf W. Bladder cancer. Lancet. 2016 Dec 3;388(10061):2796-2810. doi: 10.1016/S0140-6736(16)30512-8. Epub 2016 Jun 23.

Reference Type DERIVED
PMID: 27345655 (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)

Provided Documents

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Document Type: Study Protocol, Statistical Analysis Plan, and Informed Consent Form

View Document

Other Identifiers

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SWOG-S1011

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

NCI-2011-02604

Identifier Type: REGISTRY

Identifier Source: secondary_id

S1011

Identifier Type: -

Identifier Source: org_study_id