- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02969278
Groin Sentinel Node Biopsy and 18FDG-PET/CT in cN0 Vulvar Cancer Patients Candidate to Standard Lymphadenectomy (GroSNaPET)
Study on the Prediction of Groin Lymphonodal Status Through 18FDG-PET/CT Combined With Sentinel Lymph Node Biopsy in Bulky a/o Multifocal a/o Pretreated Vulvar Cancer, N0 at Conventional Imaging (GRO-SNaPET Study)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Vulvar carcinoma (VC) is a rare disease (4% of gynecological cancers) and the treatment is not yet universally defined. No official guidelines are currently available to define imaging techniques useful for staging. In the pre-operative evaluation of the pateints, imaging should assess nodal status; the available exams are:
- CT or MRI with contrast (abdominal and pelvic with caudal scans for inguinal regions)
- Inguinal ultrasound with US-guided biopsy/fine needle aspiration for suspicious lymph nodes.
The incidence of inguinal and pelvic lymph node metastasis not diagnosed at the pre-operative imaging is 10-35% as assessed after lymphadenectomy at pathology report.
Until 2009, the standard surgical treatment of vulvar cancer was represented by mono or bilateral systematic lymphadenectomy (at least 70% of N0 women underwent a radical surgery with the risk of severe morbidity related to the surgical procedure with no survival benefit).
Inguinal lymphadenectomy shows a high rate of local and systemic complications resulting in a longer hospitalization or recovery, as well as possible delays in adjuvant therapies.
Moreover, severe complications can lead to a further surgery.
Possibile complications described in literature are:
- Lymphedema (up to 70%)
- Infection and postoperative cellulitis (50%)
- Inguinal suture dehiscence (between 22 and 52%)
- Linfocysts (between 7 and 28%)
- Deep vein thrombosis (between 5 and 8%)
- Sepsis (1 -2%)
Since 2009, with the introduction and the validation of sentinel node biopsy (SNB), for some VC it is now possible to obtain a nodal staging with minimally invasive surgery and lower morbidity. However, the SNB technique is indicated if the tumor fits the following selection criteria:
- Infiltrating tumors with a diameter < 40 mm;
- Monofocal tumors;
- Tumors distant more than 1 cm from the midline
- Tumors near the midline with bilateral lymphatic drainage and intraoperative detection of at least one sentinel node for each groin.
Consequently in many tumors diagnosed as N0 at preoperative imaging, SNB technique is not indicated; these tumors still require systematic lymphadenectomy.
In this subset of patients it is important to identify new methods for preoperative evaluation of nodal status or to define a sub-category of patients for which the SNB could be applied.
Objective of the study is to verify, in patients actually off-label for SNB, the accuracy of 18FDG-PET/CT in predicting nodal status, as an indipendent method or associated with the standard pre-operative imaging and the mini-invasive surgical staging.
All patients are submitted to:
- Gynecologic visit
- Vulvar biopsy and possible pelvic examination under anesthesia with the definition of clinical extent of disease
- Evaluation of serum tumor markers: SCC and Ca125
- Inguinal ultrasound and possible US guided FNAC or FNAB on suspicious lymph nodes
- CT scan (abdomen and pelvis) with contrast
- 18FDG-PET/CT
- Lymphangioscintigraphy of inguinofemoral axis
Vulvar surgery may include:
- Wide resection of vulvar disease
- Emivulvectomy (anterior, posterior or lateral)
- Simple vulvectomy
- Radical or ultra-radical vulvectomy (with possible plastic reconstruction)
During inguinal surgery all patients will undergo:
- Sentinel node biopsy mono or bilateral followed by radical bilateral inguinal lymphadenectomy
Statistical analysis will help determine the accuracy and negative predictive value of FDG-PET/CT and sentinel node biopsy in predicting nodal status.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
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Rome, Italy, 00168
- Recruiting
- Division of Gynecologic Oncology/Fondazione Policlinico Gemelli
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Principal Investigator:
- Alessandro Giordano, Professor
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Sub-Investigator:
- Vittoria Rufini, Professor
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Sub-Investigator:
- Simona M Fragomeni, MD
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age> 18 years
- ECOG ≤ 2
- Adequate respiratory, hepatic, cardiac, bone marrow and renal function (creatinine clearance> 60 mL/min according to the Cockroft formula)
- Patient psychologically able to follow the study procedures
- Signature of informed consent
In addition, both major criteria and at least one of the minor criteria must be present:
MAJOR CRITERIA
- Vulvar carcinoma (stromal infiltration > 1 mm); Histotypes different from squamous are included
- Negative lymphnodes at preoperative imaging
MINOR CRITERIA
- Vulvar lesion greater than 4 cm
- Multifocal or bilateral lesions
- Previous complete excisional biopsy of the vulvar lesion, with absent residual disease
- Previous neoadjuvant treatment (radiotherapy a/o sequential/concomitant chemotherapy)
- Previous treatment with radiotherapy a/o chemotherapy (sequential a/o concomitant) for previous vulvar cancer a/o other diseases
- Previous vulvar or inguinal surgery
- Infiltrating vulvar carcinoma with monolateral groin lymphnode involvement (N1) and contralateral N0
Exclusion Criteria:
- Allergy to egg proteins and albumin
- Pregnancy and breastfeeding
- Patients with impaired respiratory, hepatic, cardiac, bone marrow and renal function (creatinine clearance> 60 mL / min according to the Cockroft formula)
- Patients with major depressive disorder
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: NA
- Interventional Model: SINGLE_GROUP
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Vulvar cancer patients cN0 unfit for sentinel node biopsy
All invasive vulvar cancer patients with cN0 status:
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Nuclear medicine exam (18FDG-PET/TC) to assess the status of the regional groin and pelvic lymphnodes
Intradermal injection of 0.2 ml 37-148 MBq of radiocolloid and a blue dye near the tumor to locate the position of the sentinel lymph node.
Intraoperatively, sentinel node localization is guided by a gamma probe and by the eyes of the surgeon who detects the lymph nodes that are stained with the blue dye.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Accuracy and Negative Predictive Value of sentinel node biopsy in cN0 vulvar cancer patients that do not fit for the current indications
Time Frame: within the first 30 days after surgery
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within the first 30 days after surgery
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Accuracy and Negative Predictive Value of preoperative 18F FDG-PET/CT for the selection of cN0 patients.
Time Frame: within the first 60 days before surgery
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within the first 60 days before surgery
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Collaborators and Investigators
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- GroSNaPET
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Vulvar Cancer
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Gynecologic Oncology GroupNational Cancer Institute (NCI)Active, not recruitingStage III Vulvar Cancer | Vulvar Squamous Cell Carcinoma | Stage I Vulvar Cancer | Stage II Vulvar CancerUnited States, Canada
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Gynecologic Oncology GroupNational Cancer Institute (NCI)CompletedLymphedema | Perioperative/Postoperative Complications | Stage II Vulvar Cancer AJCC v7 | Stage IIIA Vulvar Cancer AJCC v7 | Stage IIIB Vulvar Cancer AJCC v7 | Stage IIIC Vulvar Cancer AJCC v7 | Stage IVA Vulvar Cancer AJCC v7 | Stage IA Vulvar Cancer AJCC v7 | Stage IB Vulvar Cancer AJCC v7 | Stage IVB...United States
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M.D. Anderson Cancer CenterNational Cancer Institute (NCI)RecruitingStage II Vulvar Cancer AJCC v8 | Stage IIIC Vulvar Cancer AJCC v8 | Stage IVA Vulvar Cancer AJCC v8 | Stage III Vulvar Cancer AJCC v8 | Stage IIIA Vulvar Cancer AJCC v8 | Stage IIIB Vulvar Cancer AJCC v8United States
-
Gynecologic Oncology GroupNational Cancer Institute (NCI)Active, not recruitingStage III Vulvar Cancer AJCC v7 | Stage IIIA Vulvar Cancer AJCC v7 | Stage IIIB Vulvar Cancer AJCC v7 | Stage IIIC Vulvar Cancer AJCC v7 | Vulvar Squamous Cell Carcinoma | Stage IVA Vulvar Cancer AJCC v7United States
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AGO Research GmbHNot yet recruitingRecurrent Vulvar Cancer | Persistent Vulvar Cancer | Metastatic Vulva Cancer | Locally Advanced Vulvar Cancer
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University of BaselUniversity Hospital Inselspital, Berne; Foundation Cancer Research SwitzerlandUnknownWomen With Vulvar Intraephitelial Neoplasia or Vulvar CancerSwitzerland, Germany
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Gynecologic Oncology GroupNational Cancer Institute (NCI)TerminatedLymphedema | Stage I Uterine Corpus Cancer | Stage II Uterine Corpus Cancer | Stage III Uterine Corpus Cancer | Stage IV Uterine Corpus Cancer | Stage III Vulvar Cancer | Stage IVB Vulvar Cancer | Stage 0 Cervical Cancer | Stage 0 Vulvar Cancer | Stage I Vulvar Cancer | Stage IA Cervical Cancer | Stage IB Cervical... and other conditionsUnited States
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