German-funded Laparoscopic Approach to Cervical Cancer

NCT ID: NCT06489795

Last Updated: 2025-02-03

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

NA

Total Enrollment

756 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-07-17

Study Completion Date

2034-01-31

Brief Summary

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The G-LACC trial is a prospective, interventional, multicenter, open-label, randomized and controlled non-inferiority operative trial.

The main goal of this clinical trial is to evaluate the non-inferiority of minimally invasive radical hysterectomy in contrast to abdominal radical hysterectomy in patients with early-stage cervical cancer. In the case of SHAPE criteria, surgery may also be performed as minimally invasive or abdominal simple hysterectomy. The primary criterion for assessment is disease-free survival (DFS). As secondary outcomes, overall survival (OS), disease recurrence, quality of life, intra-/postoperative complications, and serious adverse events are recorded for assessment.

Detailed Description

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Eligible patients will be randomly allocated to both treatment arms in a 1:1 ratio. Within an accrual period of 4 years, 378 patients will be included per arm (756 in total) across all sites. The Follow-up period after surgery will take a minimum of 5 years.

In the standard arm, radical hysterectomy is performed as per standard technique abdominal radical hysterectomy (Piver type 2 or 3 or Querleu \& Morrow Type B or C) with salpingectomy +/- oophorectomy. Ovaries may be removed or preserved +/- transposition. Surgery includes pelvic lymph node dissection or optional sentinel lymph node biopsy (SNB) according to current guidelines in both arms.

In the experimental arm, radical hysterectomy is performed as per standard conventional 2D/3D laparoscopic or robotic assisted technique (Querleu \& Morrow Type B or C) with salpingectomy +/- oophorectomy. Ovaries may be removed or preserved +/- transposition. The following protective measures are mandatory for the minimally invasive arm: LEEP/conization prior to randomization or vaginal closure prior to colpotomy. Transcervical manipulators are not permitted. Use of uterus manipulators/ cervical adapter (without transcervical device) is allowed only after LEEP/conization. Meticulous dissection of pelvic (sentinel) lymph nodes including use of endobags and avoiding the dissemination of cancer cells will be implemented (tumor hygiene).

Due to the positive results of the SHAPE trial published at Plante et al. NEJM 2024, in both arms simple hysterectomy can be considered for patients with low-risk early-stage cervical cancer (SHAPE criteria: tumor \< 2 cm, \< 10 mm depth of stromal invasion (LEEP/cone) BUT has to be determined BEFORE randomization. Simple hysterectomy has to be performed as extrafascial hysterectomy and the preparation of a max. 5 mm vaginal cuff is required to ensure negative margins. Surgery can be performed including removal of the sentinel lymph nodes following the concept of sentinel lymph node biopsy (SNB) and according to the current guidelines.

Conditions

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Cervical Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Interventional, multicenter, open-label, randomized, controlled non-inferiority trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Experimental intervention: Laparoscopic or robot-assisted radical/simple hysterectomy

In the experimental arm, patients with early-stage cervical cancer will be treated by using laparoscopic or robot-assisted radical/simple hysterectomy.

Group Type EXPERIMENTAL

Laparoscopic or robot-assisted radical/simple hysterectomy

Intervention Type PROCEDURE

In the experimental arm, patients with early-stage cervical cancer will be treated by using laparoscopic or robot-assisted radical, or in the case of SHAPE criteria, simple hysterectomy.

Control intervention: Abdominal radical/simple hysterectomy

In the control arm, abdominal radical/simple hysterectomy (ARH) will be used as standard therapy.

Group Type OTHER

Abdominal radical/simple hysterectomy

Intervention Type PROCEDURE

In the control arm, patients with early-stage cervical cancer will be treated by using abdominal radical, or in the case of SHAPE criteria, simple hysterectomy as standard therapy.

Interventions

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Laparoscopic or robot-assisted radical/simple hysterectomy

In the experimental arm, patients with early-stage cervical cancer will be treated by using laparoscopic or robot-assisted radical, or in the case of SHAPE criteria, simple hysterectomy.

Intervention Type PROCEDURE

Abdominal radical/simple hysterectomy

In the control arm, patients with early-stage cervical cancer will be treated by using abdominal radical, or in the case of SHAPE criteria, simple hysterectomy as standard therapy.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Histologically confirmed primary adenocarcinoma, squamous cell carcinoma or adenosquamous carcinoma of the uterine cervix
2. Patients with FIGO stage IA2, IB1, or IB2 disease (\<4 cm)
3. Patients undergoing radical hysterectomy according either to Type II or III (Piver Classification) or to Type B or C (Querleu and Morrow classification)

OR

Simple hysterectomy can be considered for patients with low-risk early-stage cervical cancer (SHAPE criteria: tumor \< 2cm, \< 10 mm depth of stromal invasion (LEEP/cone). Simple hysterectomy has to be performed as extrafascial hysterectomy and the preparation of a max. 5mm vaginal cuff is required to ensure negative margins.
4. Performance status of ECOG 0-1
5. Patient must be suitable candidates for surgery with preoperative MRI and available for assessment of serious adverse events up to one year post-surgery
6. Patients who have signed an approved Informed Consent
7. Patients with a prior malignancy only if \> 5 years previous with no evidence of disease
8. Females, aged 18 years or older

Exclusion Criteria

1. Any histology other than an adenocarcinoma, squamous cell carcinoma, or adenosquamous carcinoma of the uterine cervix
2. Tumor size of 4 cm and greater, estimated by either magnetic resonance imaging (MRI) or clinical examination
3. FIGO stage IB3 - IV
4. Patients with a history of pelvic or abdominal radiotherapy
5. Patients with evidence of metastatic disease by conventional imaging studies, enlarged pelvic or aortic lymph nodes \> 2 cm, or histologically positive lymph nodes
6. Serious concomitant systemic disorders incompatible with the study (at the discretion of the investigator)
7. Patients unable to withstand prolonged lithotomy and steep Trendelenburg position
8. Patient compliance and geographic proximity that do not allow adequate follow-up
9. Women who are pregnant
10. Patients with contraindications to surgery
11. Patients with secondary invasive neoplasm in the last 5 years (except non-melanoma skin cancer, breast cancer T1 N0 M0 grade 1 or 2 without any signs of recurrence or activity)
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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German Cancer Aid

OTHER

Sponsor Role collaborator

Hannover Medical School

OTHER

Sponsor Role lead

Responsible Party

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Peter Hillemanns

Prof. Dr. med., Director Department of Gynecology and Obstetrics

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Peter Hillemanns, Prof. Dr.

Role: PRINCIPAL_INVESTIGATOR

Hannover Medical School, Department of Gynecology and Obstetrics

Locations

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Ludwigsburg Hospital, Department of Gynecology and Obstetrics

Ludwigsburg, Baden-Wurttemberg, Germany

Site Status RECRUITING

University Medical Center Tübingen, Department of Gynecology

Tübingen, Baden-Wurttemberg, Germany

Site Status RECRUITING

Hochtaunus-Clinics Bad Homburg, Department of Gynecology

Bad Homburg, Hesse, Germany

Site Status RECRUITING

University Medical Center Göttingen, Department of Gynecology and Obstetrics

Göttingen, Lower Saxony, Germany

Site Status RECRUITING

Hannover Medical School, Department of Gynecology and Obstetrics

Hanover, Lower Saxony, Germany

Site Status RECRUITING

Hospital Lüneburg, Department of Gynecology

Lüneburg, Lower Saxony, Germany

Site Status RECRUITING

Hospital Bielefeld - Center, Department of Gynecology

Bielefeld, North Rhine-Westphalia, Germany

Site Status RECRUITING

University Medical Center Düsseldorf, Department of Gynecology and Obstetrics

Düsseldorf, North Rhine-Westphalia, Germany

Site Status RECRUITING

Protestant Hospital Wesel, Gynecological Cancer Center

Wesel, North Rhine-Westphalia, Germany

Site Status RECRUITING

University Medical Center Mainz, Department of Obstetrics and Gynecology

Mainz, Rhineland-Palatinate, Germany

Site Status RECRUITING

University Hospital Schleswig-Holstein, Campus Kiel, Department of Gynecology and Obstetrics

Kiel, Schleswig-Holstein, Germany

Site Status RECRUITING

Vivantes Auguste-Viktoria-Hospital, Department of Gynecology

Berlin Schöneberg, State of Berlin, Germany

Site Status RECRUITING

Martin Luther Hospital Berlin, Department of Gynecology and Obstetrics

Berlin, , Germany

Site Status RECRUITING

University Medical Center Hamburg-Eppendorf, Department of Gynecology

Hamburg, , Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Peter Hillemanns, Prof. Dr.

Role: CONTACT

+49 (0) 511 532 ext. 6144

Oliver Papp

Role: CONTACT

+49 (0) 176 1532 ext. 7234

Facility Contacts

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Sebastian Berlit, Prof. Dr.

Role: primary

+49 (0) 7141 99 ext. 67601

Sara Y. Brucker, Prof. Dr.

Role: primary

+49 (0) 7071 29 ext. 80791

Dominik Denschlag, Prof. Dr.

Role: primary

+49 (0) 6172 14 ext. 2580

Julia Gallwas, Prof. Dr.

Role: primary

+49 (0) 551 396 ext. 2501

Peter Hillemanns, Prof. Dr.

Role: primary

+49 (0) 511 532 ext. 6144

Hermann Hertel, Prof. Dr.

Role: backup

+49 (0) 511 532 ext. 9760

Peter Dall, Prof. Dr.

Role: primary

+49 (0) 4131 77 ext. 2231

Werner Bader, Prof. Dr.

Role: primary

+49 (0) 521 581 ext. 3271

Tanja Fehm, Prof. Dr.

Role: primary

+49 (0) 211 81 ext. 17501

Nicole Sigrist-Uhl

Role: primary

+49 (0) 281 106 ext. 2700

Roxana Schwab, PD Dr.

Role: primary

+49 (0) 6131 17 ext. 7574

Ibrahim Alkatout, Prof. Dr.

Role: primary

+49 (0) 431 500 ext. 21407

Farnaz Jakubek

Role: primary

+49 (0) 30 130 20 ext. 2402

Uwe A. Ulrich, Prof. Dr.

Role: primary

+49 (0) 30 8955 ext. 3311

Jan Dieckmann, Dr.

Role: primary

+49 (0) 40 7410 ext. 23800

Other Identifiers

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G-LACC

Identifier Type: -

Identifier Source: org_study_id

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