"Wait-and-see" Policy for Complete Responders After Chemoradiotherapy for Rectal Cancer

NCT ID: NCT03426397

Last Updated: 2020-07-29

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

RECRUITING

Total Enrollment

220 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-05-10

Study Completion Date

2026-06-01

Brief Summary

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The aim of this prospective observational cohort study is to provide short and long term oncological and functional outcome data on organ preserving treatment in good responders after a standard indication for neoadjuvant (chemo)radiation for rectal cancer.

Detailed Description

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Standard treatment for patients with locally advanced rectal cancer consists of a long course of (CRT) followed by surgical resection. Although the aim of neoadjuvant treatment in these patients is not organ preservation, but rather to provide improved local control, in the tumour disappears completely. Studies from Maastricht, the UK and Brazil have shown that in selected patients with a clinical complete response after CRT, a "wait-and-see" policy without any surgery could be a safe alternative with comparable long-term outcome and better functional outcome compared to patients who had surgery.

The main objective of the study is to provide short and long term oncological and functional outcome data on organ preserving treatment in good responders after a standard indication for neoadjuvant (chemo)radiation. Additional aims are: to set up a national network with expertise centres in the 'wait-and-see' treatment of rectal cancer; to set up a national registry for organ preservation treatment that will generate more evidence on the management and oncological outcome of patients evaluated and treated with organ preservation and \[3\] to offer through this network to all patients who are considered good candidates this 'wait-and-see' approach using the most up to date tools for selection and follow-up.

Study design: multicenter prospective observational cohort study and implementation study. Study population: The population will consist of patients, aged 18 years or older, with rectal cancer who after a long course of CRT or a short course of radiation with a long waiting interval have a clinical complete response (ycT0N0).

The main study endpoint is 2-year non-regrowth disease-free survival. Secondary endpoints are \[1\] the number of fully operational centres who can deliver high quality organ preserving care in rectal cancer in the Netherlands, \[2\] 2-year regrowth rate, \[3\] 2-year local control, \[4\] 2-year overall survival, \[5\] determination of the optimal follow-up schedule and \[6\] quality of life.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: In the majority of patients who participate in the study, major surgery and the associated morbidity can be avoided. Although scientific proof shows "wait-and-see" only comes with a small risk with adequate selection and follow up, the exact risk is not yet well established and needs to be confirmed by this study. The benefit-risk ratio for this study is regarded as favourable.

Conditions

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Rectal Neoplasms

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Study population

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Aged 18 years or older
* Primary rectal cancer (pathologically confirmed)
* Treated with neoadjuvant (chemo)radiotherapy
* Clinical complete response (ycT0N0) to neoadjuvant treatment, as determined clinically (digital rectal examination, endoscopy) and radiologically (diffusion weighted imaging-MRI).
* Informed consent and capability of giving informed consent; before informed consent is obtained the patient will be extensively informed about the fact that 'wait-and-see' instead of conventional surgery is not accepted yet by most physicians and that the risks and benefits from these strategies have not been fully determined yet. These issues will be discussed in the patient information form as well.
* Comprehension of the alternative strategies and risks are clear to the patient (in other words that the patient understands the experimental base of the study).

Exclusion Criteria

* Recurrent rectal cancer
* Contra-indications for MRI. If MRI is not possible because of contra-indications (e.g. pacemaker) patients will be excluded. MRI is crucial for response evaluation and follow-up and cannot be omitted in patients that follow the 'wait-and-see policy'.
* Unable to understand or read Dutch
* Unable or unwilling to comply to the intensive follow-up schedule
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Dutch Cancer Society

OTHER

Sponsor Role collaborator

The Netherlands Cancer Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Geerard Beets, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Antoni van Leeuwenhoek - Netherlands Cancer Institute

Regina Beets -Tan, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Antoni van Leeuwenhoek - Netherlands Cancer Institute

Locations

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Universitair Ziekenhuis Antwerpen

Antwerp, , Belgium

Site Status RECRUITING

Antoni van Leeuwenhoek

Amsterdam, , Netherlands

Site Status RECRUITING

VU Medisch Centrum

Amsterdam, , Netherlands

Site Status NOT_YET_RECRUITING

Amphia Ziekenhuis

Breda, , Netherlands

Site Status NOT_YET_RECRUITING

Deventer Ziekenhuis

Deventer, , Netherlands

Site Status RECRUITING

Westfriesgasthuis

Hoorn, , Netherlands

Site Status RECRUITING

Leeuwarden Medisch Centrum

Leeuwarden, , Netherlands

Site Status NOT_YET_RECRUITING

Leiden University Medical Center

Leiden, , Netherlands

Site Status NOT_YET_RECRUITING

Maastricht University Medical Centre

Maastricht, , Netherlands

Site Status RECRUITING

Radboud UMC

Nijmegen, , Netherlands

Site Status RECRUITING

Elisabeth Tweesteden Ziekenhuis

Tilburg, , Netherlands

Site Status NOT_YET_RECRUITING

Diakonessenhuis

Utrecht, , Netherlands

Site Status NOT_YET_RECRUITING

Universitair Medisch Centrum Utrecht

Utrecht, , Netherlands

Site Status NOT_YET_RECRUITING

Isala Klinieken

Zwolle, , Netherlands

Site Status RECRUITING

Countries

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Belgium Netherlands

Central Contacts

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Marit van der Sande, MD

Role: CONTACT

0031205129111

Facility Contacts

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Marit van der Sande, MD

Role: primary

References

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Meyer VM, Meuzelaar RR, Schoenaker IJH, de Groot JB, Reerink O, de Vos Tot Nederveen Cappel WH, Beets GL, van Westreenen HL. Delayed TME Surgery in a Watch-and-Wait Strategy After Neoadjuvant Chemoradiotherapy for Rectal Cancer: An Analysis of Hospital Costs and Surgical and Oncological Outcomes. Dis Colon Rectum. 2023 May 1;66(5):671-680. doi: 10.1097/DCR.0000000000002259. Epub 2021 Nov 24.

Reference Type DERIVED
PMID: 34856587 (View on PubMed)

Other Identifiers

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M16WAS

Identifier Type: -

Identifier Source: org_study_id

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