Comparison of Esophagectomy and Chemoradiation for Patients With cN0-pT1b Stage Esophageal Squamous Cell Carcinoma

NCT ID: NCT04135664

Last Updated: 2019-10-22

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

Clinical Phase

PHASE3

Total Enrollment

176 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-09-01

Study Completion Date

2027-12-01

Brief Summary

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The ad-ESD trial is phase III randomized trial to compare adjuvant esophagectomy and chemoradiation for patients with clinical stage N0 and pathological stage T1b squamous cell carcinoma (after endoscopic submucosal dissection).

Detailed Description

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Esophagectomy is still the primary treatment for pathological T1b esophageal squamous cell carcinoma. However, esophagectomy is associated with high mortality and morbidity and decreased quality of life. Endoscopic resection followed with chemoradiation had showed uncompromised oncological outcomes with esophagectomy. But there is no well-designed, phase III trial to compare the two treatment for patients with pT1b squamous cell carcinoma.

The ad-ESD trial is a multi-center prospective superiority trial, combied of a randomized clinical trial and a prospective registry.

The experimental design produces two randomized arms; (1) esophagectomy and (2) chemoradiation. An additional registry arm will be based on surgeons/patients that do not want to be randomised because of their own experience on adjuvant therapy, including esophagectomy; chemoradiation and active surveillance.

The primary endpoint is to evaluate the difference of 5-year overall survival rate between definitive chemoradiation and esophagectomy, in patients with cN0-pT1b esophageal squamous cell cancer (ESCC) after endoscopic resection.

The secondary endpoints are to evaluate the difference of quality of life and oncological outcomes including 3-year overall survival (OS) and 3, 5-year relapse free survival (RFS) between the two treatments.

Conditions

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Esophageal Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Patients undergoing adjuvant esophagectomy

Patients underwent endoscopic submucosal dissection and diagnosed with pathological-T1b and clinical-N0 squamous cell carcinoma.

Patients randomized into undergoing adjvant esophagectomy.

Group Type ACTIVE_COMPARATOR

esophagectomy

Intervention Type PROCEDURE

esophagectomy with at least two-field (thoracic-abdominal) lymphadenectomy

Patients undergoing adjuvant chemoradiation

Patients underwent endoscopic submucosal dissection and diagnosed with pathological-T1b and clinical-N0 squamous cell carcinoma.

Patients randomized into undergoing adjvant chemoradiation.

Group Type EXPERIMENTAL

chemoradiation

Intervention Type COMBINATION_PRODUCT

concurrent chemotherapy and radiotherapy

Prospective registry of patients that cannot be randomized

Patients underwent endoscopic submucosal dissection and diagnosed with pathological-T1b and clinical-N0 squamous cell carcinoma.

Patients cannot be randomized into undergoing adjvant esophagectomy or chemoradiaton.

This arm includes patients undergoing adjuvant esophagectomy; adjuvant chemoradiation and active surveillance.

Group Type ACTIVE_COMPARATOR

esophagectomy

Intervention Type PROCEDURE

esophagectomy with at least two-field (thoracic-abdominal) lymphadenectomy

chemoradiation

Intervention Type COMBINATION_PRODUCT

concurrent chemotherapy and radiotherapy

active surveillance

Intervention Type OTHER

No further adjuvant therapy

Interventions

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esophagectomy

esophagectomy with at least two-field (thoracic-abdominal) lymphadenectomy

Intervention Type PROCEDURE

chemoradiation

concurrent chemotherapy and radiotherapy

Intervention Type COMBINATION_PRODUCT

active surveillance

No further adjuvant therapy

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Biopsy proven with esophageal squamous cell cancer.
* Clinical N0 stage diagnosed by imaging examinations.
* Pathological T1b stage confirmed by endoscopic submucosal dissection.
* Age: 18-75.
* Tumor located at the thorax.
* Performance status Eastern Cooperative Oncology Group (ECOG) performance status 0-1.
* Written informed consent.

Exclusion Criteria

* Prior intervention treatment before endoscopic submucosal resection.
* Inability to accept any treatment component.
* Prior intervention (surgery, chemoradiation, et al.) for other primary tumor disease.
* Distant metastasis.
* The circumference of the lumen over 3/4
* Main tumor size \> 5cm assessed by endoscopy
* Inability to understand the informed consent.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Shanghai Chest Hospital

OTHER

Sponsor Role lead

Responsible Party

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Zhigang Li

Chief of Department of Esophageal Surgery, Deputy of Department of Thoracic Surgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Zhigang Li, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Shanghai Chest Hospital of Shanghai Jiao Tong University

Locations

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The First Affiliated Hospital of Nanchang University

Nanchang, Jiangxi, China

Site Status ACTIVE_NOT_RECRUITING

Changhai Hospital, The Second Military Medical University

Shanghai, , China

Site Status ACTIVE_NOT_RECRUITING

Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine

Shanghai, , China

Site Status ACTIVE_NOT_RECRUITING

Shanghai Chest Hospital, Shanghai Jiao Tong University

Shanghai, , China

Site Status RECRUITING

Zhongshan Hospital, Fudan University

Shanghai, , China

Site Status ACTIVE_NOT_RECRUITING

Tianjin Medical University Cancer Institute and Hospital

Tianjin, , China

Site Status ACTIVE_NOT_RECRUITING

Countries

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China

Central Contacts

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Zhigang Li, MD

Role: CONTACT

18960619260 ext. 18960619260

Xiaobin Zhang, MD

Role: CONTACT

18516302162 ext. 18516302162

Facility Contacts

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Zhigang Li, Doctor

Role: primary

86-18930619260 ext. 18960619260

References

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Al-Batran SE, Koch C. Neoadjuvant therapy for oesophageal cancer: refining the armamentarium. Lancet. 2024 Jul 6;404(10447):5-7. doi: 10.1016/S0140-6736(24)01084-5. Epub 2024 Jun 11. No abstract available.

Reference Type DERIVED
PMID: 38876135 (View on PubMed)

Yang Y, Su Y, Zhang X, Liu J, Zhang H, Li B, Hua R, Tan L, Chen H, Li Z. Esophagectomy versus definitive chemoradiotherapy for patients with clinical stage N0 and pathological stage T1b esophageal squamous cell carcinoma after endoscopic submucosal dissection: study protocol for a multicenter randomized controlled trial (Ad-ESD Trial). Trials. 2020 Jul 1;21(1):603. doi: 10.1186/s13063-020-04461-5.

Reference Type DERIVED
PMID: 32611448 (View on PubMed)

Other Identifiers

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Chest201908

Identifier Type: -

Identifier Source: org_study_id

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