Preoperative Concurrent Chemotherapy and Intensity Modulated Radiotherapy (IMRT) in Locally Advanced Rectal Cancer

A Phase II Trial of Preoperative Concurrent Chemotherapy and (IMRT) in Locally Advanced Rectal Cancer

The hypothesis of this study is that dose escalated intensity modulated radiotherapy (IMRT) to a dose of 55Gy in 25# to primary rectal tumor concurrent with oral capecitabine results in an improved pathological response rate from 8% (German trial) to 25%.

Study Overview

• Status: Unknown
• Conditions: Rectal Cancers.
• Intervention / Treatment: Radiation: Intensity Modulated Radiotherapy

Detailed Description

This study aims to look at whether radiation dose escalation with intensity modulated radiotherapy can increase the rates of pathological complete response in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

• Study Type: Interventional
• Enrollment (Anticipated): 63
• Phase: Phase 2

Contacts and Locations

Study Locations

• Singapore
  • Singapore, Singapore, 119074
    • Recruiting
    • National University Hospital
    • Contact: Jeremy Tey, FRANZCR; Phone Number: + 6567724869; Email: Jeremy_tey@nuhs.edu.sg
    • Principal Investigator: Jeremy Tey, FRANZCR

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 90 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Pathologically proven diagnosis of adenocarcinoma of the rectum
• Clinically determined to be stage T3 or T4,N0-N2, and M0 -staged by MRI or transrectal ultrasound of the rectum
• Patients who are medically operable and who have resectable adenocarcinoma of the rectum at least <15cm from the anal verge
• Adequate liver/renal and haematological function.
• Eastern Cooperative Oncology Group (ECOG) performance 0-2
• Age ≥ 18 years

• Full blood count obtained within 2 weeks prior to registration on study, with adequate bone marrow function defined as follows:

  • Absolute neutrophil count (ANC) ≥ 1,800 cells/mm3
  • Platelets ≥ 100,000 cells/mm3
  • Haemoglobin ≥ 8.0 g/dl
• Serum creatinine within normal institutional limits or creatinine clearance ≥ 50 ml/min
• Bilirubin within normal institutional limits
• AST and ALT < 2.5 x the IULN
• Patient must sign study specific informed consent prior to study entry

Exclusion Criteria:

Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years

• Prior systemic chemotherapy for colorectal cancer; note that prior chemotherapy for a different cancer is allowable.
• Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields

• Severe, active comorbidity, defined as follows:

  • Unstable angina and/or congestive heart failure requiring hospitalization within the last 12 months
  • Transmural myocardial infarction within the last 6 months
  • Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
  • Acquired immune deficiency syndrome (AIDS) based upon current CDC definition; note, however, that HIV testing is not required for entry into this protocol.
  • Evidence of uncontrolled seizures, central nervous system disorders, or psychiatric disability judged by the investigator to be clinically significant, precluding informed consent, or interfering with compliance of oral drug intake.
  • Known, existing uncontrolled coagulopathy. Patients on therapeutic anticoagulation may be enrolled provided that they have been clinically stable on anti-coagulation for at least 2 weeks.
  • Major surgery within 28 days of study enrollment (other than diverting colostomy)
• Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception; this exclusion is necessary because the treatment involved in this study may be significantly teratogenic
• Prior allergic reaction to capecitabine
• Any evidence of distant metastases (M1)
• A synchronous primary colon carcinoma
• Extension of malignant disease into the anal canal
• Lack of physical integrity of the gastrointestinal tract (i.e., severe Crohn's disease that results in
• malabsorption; significant bowel resection that would make one concerned about the absorption of capecitabine) or malabsorption syndrome that would preclude feasibility of oral chemotherapy (capecitabine)
• Participation in any investigational drug study within 28 days of study enrollment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intensity modulated Radiotherapy; Intensity modulated radiotherapy, dose escalation, rectal cancer, volumetric modulated arc therapy	Radiation: Intensity Modulated Radiotherapy; Intensity modulated radiotherapy to a dose of 55Gy in 25 fractions; Other Names: Intensity modulated radiotherapy. Dose escalation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pathological complete response rates	Pathogical complete response rate 8 weeks post chemoradiotherapy at surgery according to Ryan's classification	8 weeks post chemoradiotherapy

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Toxicity	Toxicity including anorexia, nausea, vomiting, diarrhoea, dermatitis, proctitis, urinary frequency/urgency as per common toxicity criteria v3.0	2 years
Disease Free survival	Time from study entry to disease recurrence or death	2 years
Downstaging rates	percentage of patients who achieve downstaging 8 weeks post chemoradiotherapy at surgery according to TNM classification	8 weeks after chemoradiotherapy
Sphincter Preservation rates	Sphincter Preservation rates 8 weeks post chemoradiotherapy at surgery.Percentage of patients who underwent sphincter salvage surgery after chemoradiotherapy	8 weeks after chemoradiotherapy

Collaborators and Investigators

• Sponsor: National University Hospital, Singapore
• Collaborators: Tan Tock Seng Hospital
• Investigators: Principal Investigator: Jeremy Tey, FRANZCR, National University Hospital, Singapore

Publications and helpful links

General Publications

• Ryan R, Gibbons D, Hyland JM, Treanor D, White A, Mulcahy HE, O'Donoghue DP, Moriarty M, Fennelly D, Sheahan K. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology. 2005 Aug;47(2):141-6. doi: 10.1111/j.1365-2559.2005.02176.x.

Study record dates

Study Major Dates

• Study Start: January 1, 2011
• Primary Completion (Anticipated): January 1, 2013
• Study Completion (Anticipated): January 1, 2013

Study Registration Dates

• First Submitted: April 18, 2011
• First Submitted That Met QC Criteria: April 20, 2011
• First Posted (Estimate): April 22, 2011

Study Record Updates

• Last Update Posted (Estimate): April 22, 2011
• Last Update Submitted That Met QC Criteria: April 20, 2011
• Last Verified: April 1, 2011

More Information

Terms related to this study

• Keywords: Rectal cancer; Pathological complete response; Intensity modulated radiotherapy
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Intestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Colorectal Neoplasms; Rectal Neoplasms
• Other Study ID Numbers: B/09/377