CT and MRI in Preoperative Colon Cancer Staging

NCT ID: NCT05727007

Last Updated: 2023-10-10

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

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-01-23

Study Completion Date

2023-05-15

Brief Summary

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The objective of this study is the evaluation of different imaging methods for the optimal preoperative staging of colon cancer patients. Imaging findings will be compared with the histopathologic results of the specimen following surgical resection.

Detailed Description

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Over the last years a significant improvement in the treatment of patients with colon cancer has been reported. This has been attributed to the improvement of the staging techniques, as well as the optimization of the surgical management. However, the current five-year survival rates of colon cancer patients in European countries ranges from 32% to 64%. This variation could be due to treatment discrepancies and the lack of adherence to the international guidelines.

Surgical treatment of colon cancer includes the radical resection of the tumour (colectomy). Following resection, the specimen is histopathologically examined, the disease is staged and further treatment is determined. Neoadjuvant treatment (radiotherapy or/and chemotherapy) for colon cancer has not been yet approved, unlike rectal cancer, where neoadjuvant treatment is recommended for specific disease stages.

Preoperative staging of colon cancer aims to identify those patients with remote metastatic disease, who will, more likely, not benefit from upward surgery. Recent developments in colon cancer management, demanding more precise local disease staging, to identify those patients who will likely benefit from neoadjuvant chemotherapy, are still at a clinical trial stage.

Preoperative treatment depends on the disease stage, which is defined by the tumour's invasion in the colonic wall, the dissemination in nearby organs or lymph nodes, and the presence of distal metastases. The stage is first evaluated radiologically and then confirmed via histopathological examination of the specimen. Imaging is an already approved tool for the staging of colonic cancer, while in some studies the combination of different imaging methods has been reported to improve the initial evaluation.

Over the last years, evaluation of the circumferential resection margin (CRM) is also recommended in the preoperative staging of patients with colon cancer. This assessment is particularly important for tumours located at the cecum, right, or left colon, since these areas lack of mobile mesocolon and therefore it is possible to infiltrate the retroperitoneal resection margin.

Nevertheless, the retroperitoneal invasion of these tumours has not been evaluated adequately as a preoperative marker for both local recurrence and for the selection of patients who may benefit from neoadjuvant treatment. In various studies the percentage of retroperitoneal resection margin's infiltration was between 7-10% for cecum and right colon adenocarcinomas, while its presence was identified as a risk factor for local recurrence. The retroperitoneal surface infiltration was preoperatively evaluated with the combination of imaging methods and the findings were postoperatively compared with the histopathological features of the specimen.

A more precise, imaging based, preoperative staging, could lead to a more targeted neoadjuvant treatment for patients with advanced disease, with the introduction of chemo- and/or radiotherapy. This approach could result to the downstaging of the tumour, with better short and long term oncological results.

Conditions

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Colonic Neoplasms

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

The study will employ a prospective design
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

There will be no blindness at the level of the patient, the treating physicians (surgeon, oncologist, radiologist) and the researcher who will record the data

Study Groups

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MRI in colon cancer

All prospectively included patients with colon cancer will be preoperatively submitted to MRI for staging. The evaluation of the diagnostic accuracy will be based on the cross-examination with the CT scan and the pathology results

Group Type EXPERIMENTAL

MRI in colon cancer

Intervention Type DIAGNOSTIC_TEST

The MRI protocol will include the following imaging series: T1 and T2 in axial and coronal plane before the administration of intravenous contrast, diffuse weight imaging in axial plane and T1 after the administration of intravenous contrast

CT in colon cancer

Intervention Type DIAGNOSTIC_TEST

The CT scan protocol will include the following: per os and intravenous administration of contrast, axial slices of 0.3mm thickness and reconstruction per 1mm, multi-planar reformation and three-dimensional volume rendering

Interventions

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MRI in colon cancer

The MRI protocol will include the following imaging series: T1 and T2 in axial and coronal plane before the administration of intravenous contrast, diffuse weight imaging in axial plane and T1 after the administration of intravenous contrast

Intervention Type DIAGNOSTIC_TEST

CT in colon cancer

The CT scan protocol will include the following: per os and intravenous administration of contrast, axial slices of 0.3mm thickness and reconstruction per 1mm, multi-planar reformation and three-dimensional volume rendering

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Histologically confirmed colonic adenocarcinoma
* Patient 18 to 90 years old
* Abscence of comorbidities that may affect treatment
* Signed informed consent of the patient

Exclusion Criteria

* Inability to receive or contraindication for intravenous contrast
* Renal impairment
* Previous allergies to intravenous contrasts
* Incompatible implants with magnetic resonance imaging
* Claustrophobia
* Active sepsis or systemic infection
* Untreated physical and mental disability
* Lack of compliance with the protocol process
* Non-granting of signed informed consent
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Thessaly

OTHER

Sponsor Role collaborator

Larissa University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Effrosyni Bompou

Effrosyni Bompou Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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George Tzovaras, Prof

Role: STUDY_CHAIR

University Hospital of Larissa

Effrosyni Bompou, MSc

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Larissa

Locations

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Department of Surgery, University Hospital of Larissa

Larissa, , Greece

Site Status

Countries

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Greece

References

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Xynos E, Gouvas N, Triantopoulou C, Tekkis P, Vini L, Tzardi M, Boukovinas I, Androulakis N, Athanasiadis A, Christodoulou C, Chrysou E, Dervenis C, Emmanouilidis C, Georgiou P, Katopodi O, Kountourakis P, Makatsoris T, Papakostas P, Papamichael D, Pentheroudakis G, Pilpilidis I, Sgouros J, Vassiliou V, Xynogalos S, Ziras N, Karachaliou N, Zoras O, Agalianos C, Souglakos J; [the Executive Team on behalf of the Hellenic Society of Medical Oncology (HeSMO)]. Clinical practice guidelines for the surgical management of colon cancer: a consensus statement of the Hellenic and Cypriot Colorectal Cancer Study Group by the HeSMO. Ann Gastroenterol. 2016 Jan-Mar;29(1):3-17.

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Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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CTMR

Identifier Type: -

Identifier Source: org_study_id

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