Preoperative Radiotherapy and Local Excision in Rectal Cancer - Full Text View

Sponsors and Collaborators:	Polish Colorectal Cancer Study Group Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology Poznan University of Medical Sciences Medical University of Lublin
Information provided by:	Polish Colorectal Cancer Study Group
ClinicalTrials.gov Identifier:	NCT00738790

Purpose

According to the current opinion, local excision in rectal cancer should be limited to selected T1N0 tumours. The investigators addressed the question whether preoperative radio(chemo)therapy can expand the use of this procedure for more advanced cancers. The rationale of preoperative radiotherapy is eradication of mesorectal subclinical disease. Besides, there is a correlation between radiosensitivity of rectal cancers and low cancer aggressiveness. For this reason, conversion to abdominal surgery is needed in patients with radioresistant tumour. The investigators aim to compare the short-course radiotherapy schedule with the chemoradiation in order to determine an optimal scheme. The study hypothesis is that the chemoradiation assures 25% more patients who do not require conversion to an open surgery. In addition, the aim is to asses safety and efficiency of preoperative radiotherapy and local excision for radiosensitive rectal cancer.

Condition	Intervention	Phase
Rectal Cancer	Radiation: Short course of radiotherapy Radiation: Radiochemotherapy	Phase III

Study Type:	Interventional
Study Design:	Treatment, Randomized, Open Label, Active Control, Parallel Assignment, Safety/Efficacy Study
Official Title:	The Randomised Study of Preoperative Radiotherapy and Local Excision for Radiosensitive Rectal Cancer

Resource links provided by NLM:

MedlinePlus related topics: Cancer Radiation Therapy

U.S. FDA Resources

Further study details as provided by Polish Colorectal Cancer Study Group:

Primary Outcome Measures:

The rate of patients with downstaging after radiotherapy to pathological complete response or ypT1 disease with negative margins. [ Time Frame: Surrogate endpoint available immediatly after surgery. ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

The rate of local control, overall survival and disease-free survival and toxicity. [ Time Frame: 5 years ] [ Designated as safety issue: Yes ]

Estimated Enrollment:	102
Study Start Date:	November 2003
Estimated Study Completion Date:	November 2013
Estimated Primary Completion Date:	November 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
1: Experimental Preoperative radiotherapy with five fractions of 5 Gy during one week and boost 4 Gy after 1 week interval, total dose 29 Gy; after 6 weeks full-thickness local excision	Radiation: Short course of radiotherapy 5 x 5 Gy plus boost 4 Gy
2: Active Comparator Radiochemotherapy with 28 fractions of 1,8 Gy plus boost 5,4 Gy in 3 fractions simultaneous bolus 5-Fluorouracil and leucovorin; after 6 weeks full-thickness local excision	Radiation: Radiochemotherapy 28 x 1,8Gy plus boost 3 x 1,8 Gy with three 2-days cycles of chemotherapy during weeks 1, 3 and 5 of irradiation (the each cycle consisted of leukovorin 20 mg/m2 per day and 10-20 minutes later of 5-fluorouracil 400 mg/m2 per day, both administrated as rapid intravenous infusion)

Detailed Description:

Local excision must involve all tissue invaded on pretreatment examination. For this reason, 4-5 tatoos of mucosa at the tumour border should be performed before the onset of treatment. Next, the long-course radiochemotherapy or short-course radiotherapy is randomly allocated. After 6 weeks interval, the full thickness local excision should be carried out with 1 cm margin. Patients with good pathological response (complete response or downstaging to ypT1 disease)are followed up. Conversion to open surgery is offered to patients with poor pathological response (ypT2-3 or positive margin). Close follow-up is carried out in order to detect an early local recurrence either in a bowel wall or in mesorectal lymph nodes. Rescue surgery is offered in patients with local recurrence.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Biopsy proven good or moderately differentiated adenocarcinoma of rectum
Extraperitoneal tumour (< 3-4 cm; unfavourable cT1 or cT2-3; N0)
No evidence of distant metastases on chest X-ray and abdominal CT or sonography
Signed by patient written informed consent

Exclusion Criteria:

Poorly differentiated pathology (G3)
Patients unfit for chemotherapy
No agreement for randomisation

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00738790

Contacts

Contact: Wojciech Michalski, M. S.

+48226433909

W.Michalski@coi.waw.pl

Locations

Poland
M. Sklodowska-Curie Memorial Cancer Centre	Recruiting
Warsaw, Poland, 02-781
Contact: Krzysztof Bujko, Prof. +48226439287 bujko@coi.waw.pl
Principal Investigator: Krzysztof Bujko, Prof.

Sponsors and Collaborators

Polish Colorectal Cancer Study Group

Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology

Poznan University of Medical Sciences

Medical University of Lublin

Investigators

Principal Investigator:

Krzysztof Bujko, Prof.

Roentgena 5, 02-781 Warsaw, Poland

More Information

Publications:

Bujko K, Sopylo R, Kepka L. Local excision after radio(chemo)therapy for rectal cancer: is it safe? Clin Oncol (R Coll Radiol). 2007 Nov;19(9):693-700. Epub 2007 Sep 4. Review.

Responsible Party:	Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology in Warsaw ( Prof. Marek P. Nowacki )
Study ID Numbers:	PGBRJG0108, KBN0655/P05/2005/28
Study First Received:	August 19, 2008
Last Updated:	August 19, 2008
ClinicalTrials.gov Identifier:	NCT00738790 History of Changes
Health Authority:	Poland: Ministry of Science and Higher Education

Keywords provided by Polish Colorectal Cancer Study Group:

rectal cancer
preoperative radiotherapy and local excision

Study placed in the following topic categories:

Digestive System Neoplasms
Rectal Neoplasms
Gastrointestinal Diseases
Rectal Neoplasm
Leucovorin
Folinic Acid
Intestinal Diseases

Rectal Diseases
Intestinal Neoplasms
Digestive System Diseases
Rectal Cancer
Fluorouracil
Gastrointestinal Neoplasms
Colorectal Neoplasms

Additional relevant MeSH terms:

Neoplasms
Digestive System Diseases
Neoplasms by Site
Digestive System Neoplasms
Gastrointestinal Diseases
Rectal Neoplasms

Gastrointestinal Neoplasms
Intestinal Diseases
Rectal Diseases
Intestinal Neoplasms
Colorectal Neoplasms

ClinicalTrials.gov processed this record on September 11, 2009