Resource-Sparing Curative Treatment for Rectal Cancer

NCT ID: NCT01459328

Last Updated: 2011-10-25

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

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

350 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-09-30

Brief Summary

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This is a prospective, multicentre, randomized clinical trial comparing two different neo-adjuvant radiation-based strategies prior to intended surgery for locally advanced adenocarcinoma of the rectum.

This trial may establish the investigational therapy to be superior to, or at least not inferior to conventional treatment.

Detailed Description

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This phase III randomised clinical trial compares the outcome of two different neo-adjuvant radiation based treatments for locally advanced rectal carcinoma. This encompasses patients at risk for a positive circumfrential resection margin (CRM+) on baseline assessment imaging and pateints identified as being with a T-descriptor T4 at baseline assessment.

The arms compared are as follows:

* The investigational arm: short chemo-radiation course(25Gy in 5 daily fractions over 1 week) +/- surgery.
* The conventional arm: protracted chemo-radiation course (50Gy in 25 daily fractions over 5 weeks combined with chemotherapy)+/- surgery.

The outcomes include four domains: overall survival, biological effect, quality of life and health-related economics.

Conditions

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Rectal Carcinoma

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 A: Conventional Long Course Chemo-Radiation

Conventional long course chemo-radiation

Group Type ACTIVE_COMPARATOR

Radiotherapy

Intervention Type RADIATION

Conventional long course chemo-radiation:

* Radiation 50Gy in 25 daily fractions over 5 weeks
* Bolus 5 Fluorouracil 350mg/m2/d for 5 days
* Injected Leucovorin 20mg in both the first and last (5th) week of radiation
* Oral Capecitabine (CAPE) 825mg/m2 b.i.d. during the entire radiotherapy course over 5 weeks.

Arm B: Short Course Radiation Followed by Chemotherapy

Experimental short course radiation followed by chemotherapy.

Group Type EXPERIMENTAL

Radiotherapy

Intervention Type RADIATION

Short course radiotherapy: 25Gy in 5 daily fractions over 1 week Chemotherapy: - Bolus 5 Fluorouracil 450 mg/m2/day

* Injected Leucovorin 20 mg/m2/day for 5 days

Interventions

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Radiotherapy

Short course radiotherapy: 25Gy in 5 daily fractions over 1 week Chemotherapy: - Bolus 5 Fluorouracil 450 mg/m2/day

* Injected Leucovorin 20 mg/m2/day for 5 days

Intervention Type RADIATION

Radiotherapy

Conventional long course chemo-radiation:

* Radiation 50Gy in 25 daily fractions over 5 weeks
* Bolus 5 Fluorouracil 350mg/m2/d for 5 days
* Injected Leucovorin 20mg in both the first and last (5th) week of radiation
* Oral Capecitabine (CAPE) 825mg/m2 b.i.d. during the entire radiotherapy course over 5 weeks.

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

* 18 years of age or older
* Clinical (i.e. surgical determination) and/or diagnostic image findings consistent with c/uT4 or CRM+ (note that CRM+ must be established by MRI), primary rectal Adenocarcinoma (i.e. histology consistent with origin from rectal mucosa); these constitute LARC for the purpose of this protocol
* Treatment will be directed at the primary cancer, being clinically appropriate and given with an initial intent to cure the patient (this includes accepting up front that radiation and surgery are feasible; for surgery, this means that the patient has been determined fit for major surgery by an anaesthesiologist prior to the request for randomization)
* Performance status is sufficient to undertake the treatment in either arm (KPS\>50%)
* Patient is accessible for required follow-up and data collection
* Radiation oncologist expects survival to exceed 6 months from date of diagnosis
* Patient provides informed consent

Exclusion Criteria

* Recurrent rectal cancer
* Primary wholly in the sigmoid colon
* Considered to be arising in the anal canal
* Metastatic disease beyond the pelvis (by clinical assessment and/or diagnostic imaging)
* Contraindications to protocol RT or to protocol chemotherapy, such as one or more of the following:
* any prior RT to the pelvis; a solitary pelvic kidney within the intended radiation volume
* consideration by the most responsible radiation oncologist that the treatment volume is too large, or the amount of small bowel or other critical organs within the treatment volume is too much for safe treatment
* significantly abnormal laboratory tests such as impaired renal/liver function
* a haemoglobin that is \< 8.0 (or 80, SI) and the patient is not transfused to exceed 8.0 (or 80, SI)
* on-going medications that are not compatible with protocol neo-adjuvant chemotherapy as described in this protocol
* Significant development issues (such as with age \< 18 yr)
* Co-morbidity
* Psychiatric diagnosis
* Physical impairment
* Pregnancy or continuing breast-feeding, that precludes administration of protocol treatments, or that precludes data collection (such as likely to preclude follow-up visits or completing questionnaires)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Centre Anti Cancer Hopital Frantz Fanon

UNKNOWN

Sponsor Role collaborator

Hospital A.C. Camargo

OTHER

Sponsor Role collaborator

Credit Valley Hospital

OTHER

Sponsor Role collaborator

Instituto Nacional de Cancerologia, Columbia

OTHER_GOV

Sponsor Role collaborator

University Hospital Sestre Milosrdnice

OTHER

Sponsor Role collaborator

Minesterio de Cienca, Tecnologia y Medio Ambiente

UNKNOWN

Sponsor Role collaborator

V.N. Cancer Center GKNM Hospital

UNKNOWN

Sponsor Role collaborator

Tata Memorial Hospital

OTHER_GOV

Sponsor Role collaborator

Dr Cipto Mangunkusumo General Hospital

OTHER

Sponsor Role collaborator

National Cancer Center, Bratislava

UNKNOWN

Sponsor Role collaborator

University of Cape Town

OTHER

Sponsor Role collaborator

Catholic University of the Sacred Heart

OTHER

Sponsor Role collaborator

International Atomic Energy Agency

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Eduardo Rosenblatt

Role: PRINCIPAL_INVESTIGATOR

International Atomic Energy Agency

Locations

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Centre Anti-Cancer, Hopital Franz Fanon

Blida, , Algeria

Site Status RECRUITING

Hospital A.C. Camargo, Fundacao Antonio Prudente

São Paulo, , Brazil

Site Status RECRUITING

Credit Valley Hospital

Mississauga, Ontario, Canada

Site Status RECRUITING

Instituto Nacional de Cancerologia, Minesterio de Salud

Bogota D.C., , Colombia

Site Status RECRUITING

Department of Oncology and Nuclear Medicine, University Hospital Sestre Milosrdnice

Zagreb, , Croatia

Site Status RECRUITING

Ministerio de Cienca, Tecnologia y Medio Ambiente (CITMA)

La Habana, , Cuba

Site Status RECRUITING

Department of Radiation Oncology, V.N. Cancer Center, GKNM Hospital

Coimbatore, , India

Site Status RECRUITING

Department of Radiation Oncology, Tata Memorial Hospital

Mumbai, , India

Site Status RECRUITING

Department of Radiotherapy, Dr. Cipto Mangunkusuma National General Hospital, University of Indonesia

Jakarta, , Indonesia

Site Status RECRUITING

Instituto di Radiologia, Universita Cattolica del Sacro Cuore

Roma, , Italy

Site Status RECRUITING

National Cancer Institute

Bratislava, , Slovakia

Site Status RECRUITING

University of Cape Town

Cape Town, , South Africa

Site Status RECRUITING

Countries

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Algeria Brazil Canada Colombia Croatia Cuba India Indonesia Italy Slovakia South Africa

Central Contacts

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IAEA

Role: CONTACT

Facility Contacts

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Boualga Kada

Role: primary

+213 25 415985

Maria Leticia Gobo Silva

Role: primary

+551132729613

Jidong Lian

Role: primary

Rosalba Ospinp Pena

Role: primary

005713341997

Ana Frobe

Role: primary

+38513787468

Maria Lourdes Pernez Pena

Role: primary

+5378316040

Nagarajan Murugaiyan

Role: primary

+9104222216715

Role: backup

Reena Engineer

Role: primary

+912224177163

Role: backup

+912224177000

Sri Mutya Sekarutami

Role: primary

+62213921155

Vincenzo Valentini

Role: primary

+390630154376

Margita Pobijakova

Role: primary

+421259378579

Barbara Robertson

Role: primary

References

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Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, Bardet E, Beny A, Ollier JC; EORTC Radiotherapy Group Trial 22921. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006 Sep 14;355(11):1114-23. doi: 10.1056/NEJMoa060829.

Reference Type BACKGROUND
PMID: 16971718 (View on PubMed)

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001 Aug 30;345(9):638-46. doi: 10.1056/NEJMoa010580.

Reference Type BACKGROUND
PMID: 11547717 (View on PubMed)

Radu C, Berglund A, Pahlman L, Glimelius B. Short-course preoperative radiotherapy with delayed surgery in rectal cancer - a retrospective study. Radiother Oncol. 2008 Jun;87(3):343-9. doi: 10.1016/j.radonc.2007.11.025. Epub 2008 Feb 21.

Reference Type BACKGROUND
PMID: 18093674 (View on PubMed)

Braendengen M, Tveit KM, Berglund A, Birkemeyer E, Frykholm G, Pahlman L, Wiig JN, Bystrom P, Bujko K, Glimelius B. Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol. 2008 Aug 1;26(22):3687-94. doi: 10.1200/JCO.2007.15.3858.

Reference Type BACKGROUND
PMID: 18669453 (View on PubMed)

Other Identifiers

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E33034

Identifier Type: -

Identifier Source: org_study_id