Improving Diagnosis and Treatment for Patients With Rectal Cancer

NCT ID: NCT07054047

Last Updated: 2025-07-08

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

438 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-07-01

Study Completion Date

2031-05-31

Brief Summary

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The cancer stage information from scans guides pre-operative treatment and the type of surgery offered. The investigators are studying whether a new Magnetic Resonance Imaging (MRI) staging method can improve the accuracy of prognosis for patients diagnosed with rectal cancer. The investigators will provide consultant radiologists with the know-how to report MRI scans using this new method and compare this with the existing method. This study will test this by comparing how accurately the old versus new method predict the outcomes of patients. The existing method relies on radiologists determining if tumour has spread through the bowel wall or not and whether there are suspected malignant lymph nodes. The new method looks for tumour spread into the veins and whether or not there are tumour deposits. Our previous research has shown that the new method is much more accurate at predicting prognosis, but this finding needs to be verified by a larger multicentre study.

The investigators are also studying the patient journey, so the investigators can better understand patients' experiences and the impact that treatments have on their quality of life. The investigators wish to understand if improvements in the accuracy of prognosis from scans could change treatment decisions in future. The investigators will also compare the radiology scan prediction of prognostic factors by looking carefully at the tumour specimens.

Detailed Description

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A Retrospective and Prospective Cohort study to improve the prognostic accuracy of preoperative staging in patients diagnosed with primary rectal cancer. The intervention is the training of radiologists to implement specialised MRI reporting using the TDV staging system.

The investigators will collect anonymized scans, clinical and histopathology data from all rectal cancer patients diagnosed in 2019. The central reviewing radiologist will stage the scans by a) mrTDV and b) mrTNM into poor and good prognosis categories. The investigators will compare survival outcomes from original reports as well as the two staging systems using Kaplan-Meier and Cox Proportional-Hazard methods.

The investigators will compare prospectively collected data before and after implementation of the consensus for identifying and treating high-risk and low-risk rectal cancers. The investigators will report on the comparisons of staging, histopathology, MDT treatment decisions, resource utilisation, how patients experienced information provided for shared decision making before and after the intervention changes and quality of life measures.

Conditions

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GI Cancer

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

CROSSOVER

The study will proceed through three phases: pre-intervention, intervention, and post-implementation.

Pre-intervention - local MDT decisions based on current MRI reporting practices will be collected for six months.

Intervention - local radiologists will be trained to recognize features of mrTDV and use a standardised reporting template. We will present the retrospective and radiologists' cohort results to MDT stakeholders who will agree the optimum stage based preoperative treatment decision making policy. We will offer training as required using the 2019 retrospective cohort.

Post-intervention - local MDT decisions based on the consensus optimum stage based preoperative decision-making policy will be collected for six months.
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Control Arm Schedule

All sites will begin in the Control arm, with patients recruited to the Control Arm Schedule. Clinical investigations prior to treatment, during treatment, after surgery and during further treatment should be performed as per standard clinical practice and as clinically indicated. Each site will remain in the Control Arm Schedule for six months. There will be a transition month with no recruitment where training is undertaken. After the transition month patients are recruited to the Intervention Arm Schedule . Patients will be recruited to either the Control or Intervention arms dependent on which arm is in progress at the site at the time of recruitment. There will be no crossover of patients between the arms at any point.

Group Type NO_INTERVENTION

No interventions assigned to this group

Intervention Arm Schedule

During the transition month, all Radiologists involved in reporting rectal cancers for the MDT will be offered training in reporting of mrTDV. Results of the retrospective data analysis will be shared at the MDT teams stakeholder meeting to determine their optimum stage based preoperative treatment decision making policy. Every site will remain in the Intervention Arm Schedule for six months.

Patients will be recruited to either the Control or Intervention arms dependent on which arm is in progress at the site at the time of recruitment. There will be no crossover of patients between the arms at any point.

Group Type EXPERIMENTAL

mrTDV

Intervention Type OTHER

The training of radiologists to implement specialised MRI reporting using the TDV staging system

Retrospective cohort

Registration of all rectal cancer patients staged as non-metastatic in their site pre-treatment MDT from 1st January 2019 - 31st December 2019 should commence as soon as the site is issued the green light. The analysis of this data will be presented to their site MDT six months from the green light. Therefore, every effort should be made to complete the 2019 retrospective cohort registrations within the first three months of the trial start. We anticipate the average number of 2019 retrospective cohort patients treated for rectal cancer will be 20 per site.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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mrTDV

The training of radiologists to implement specialised MRI reporting using the TDV staging system

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Have a rectal cancer proven on biopsy or subsequent surgery
2. Sites able to submit anonymised MRI staging scans, pathology and imaging reports for central review
3. Aged 16 years or over

Exclusion Criteria

1. Have irresectable metastatic disease at time of initial staging
2. Undergoing palliative treatment for Rectal Cancer
3. Have a biopsy-proven rectal malignancy which is not adenocarcinoma
4. Are contraindicated for MRI staging
Minimum Eligible Age

16 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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NHS England

OTHER_GOV

Sponsor Role collaborator

Pelican Cancer Foundation

OTHER

Sponsor Role collaborator

Imperial College London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Gina Brown, MD

Role: PRINCIPAL_INVESTIGATOR

Imperial College London

Locations

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Southampton General Hospital

Southampton, Hampshire, United Kingdom

Site Status

John Radcliffe Hospital

Oxford, Oxfordshire, United Kingdom

Site Status

Salisbury District Hospital

Salisbury, Wiltshire, United Kingdom

Site Status

Countries

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United Kingdom

Central Contacts

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Caroline Martin

Role: CONTACT

+44 (0) 7749 655 817

Facility Contacts

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Site Principal Investigator

Role: primary

Site Principal Investigator

Role: primary

Site Principal Investigator

Role: primary

References

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Morris EJA, Finan PJ, Spencer K, Geh I, Crellin A, Quirke P, Thomas JD, Lawton S, Adams R, Sebag-Montefiore D. Wide Variation in the Use of Radiotherapy in the Management of Surgically Treated Rectal Cancer Across the English National Health Service. Clin Oncol (R Coll Radiol). 2016 Aug;28(8):522-531. doi: 10.1016/j.clon.2016.02.002. Epub 2016 Feb 28.

Reference Type BACKGROUND
PMID: 26936609 (View on PubMed)

Wilkinson E. NICE withdraws quality standard on colorectal cancer treatment after "lack of consensus". Lancet Oncol. 2022 Mar;23(3):333. doi: 10.1016/S1470-2045(22)00084-5. Epub 2022 Feb 10. No abstract available.

Reference Type BACKGROUND
PMID: 35151414 (View on PubMed)

Lord AC, D'Souza N, Shaw A, Rokan Z, Moran B, Abulafi M, Rasheed S, Chandramohan A, Corr A, Chau I, Brown G. MRI-Diagnosed Tumor Deposits and EMVI Status Have Superior Prognostic Accuracy to Current Clinical TNM Staging in Rectal Cancer. Ann Surg. 2022 Aug 1;276(2):334-344. doi: 10.1097/SLA.0000000000004499. Epub 2020 Sep 15.

Reference Type BACKGROUND
PMID: 32941279 (View on PubMed)

Lord AC, Corr A, Chandramohan A, Hodges N, Pring E, Airo-Farulla C, Moran B, Jenkins JT, Di Fabio F, Brown G. Assessment of the 2020 NICE criteria for preoperative radiotherapy in patients with rectal cancer treated by surgery alone in comparison with proven MRI prognostic factors: a retrospective cohort study. Lancet Oncol. 2022 Jun;23(6):793-801. doi: 10.1016/S1470-2045(22)00214-5. Epub 2022 May 2.

Reference Type BACKGROUND
PMID: 35512720 (View on PubMed)

Other Identifiers

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348532

Identifier Type: OTHER

Identifier Source: secondary_id

25/EM/0105

Identifier Type: OTHER

Identifier Source: secondary_id

EDGE: 176847

Identifier Type: -

Identifier Source: org_study_id

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