Comparison Between NCRT and NCT Followed by MIE for Treatment of Locally Advanced Resectable ESCC (ESCCNCRTvNCT)

September 7, 2020 updated by: Shanghai Zhongshan Hospital

Neoadjuvant Chemoradiotherapy VS. Neoadjuvant Chemotherapy Followed by Minimally Invasive Esophagectomy for Locally Advanced Resectable Esophageal Squamous Cell Carcinoma（cT3-4aN0-1M0):A Multi-center Prospective Randomized Clinical Trial

The purpose of this study is to evaluate the outcomes of neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy followed by minimally invasive esophagectomy on patients with locally advanced resectable esophageal squamous cell carcinoma(cT3-4aN0-1M0).

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

It is a prospective randomized phase III clinical trial sponsored by Shanghai Zhongshan Hospital with other eight hospitals in China participating in. 264 patients with locally advanced resectable esophageal squamous cell carcinoma(cT3-4aN0-1M0) are recruited and randomly assigned into the neoadjuvant chemoradiotherapy group (NCRT group) and the neoadjuvant chemotherapy group (NCT group) according to the proportion of 1:1.The safety,efficacy of protocols and prognosis of patients are compared between the two regimens.

Study Type

Interventional

Enrollment (Actual)

264

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • China
    • Shanghai
      • Shanghai, Shanghai, China, 200032
        • Shanghai Zhongshan Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 75 years (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Histologically-confirmed squamous cell carcinoma of the esophagus;
  2. Tumors of the esophagus are located in the thoracic cavity;
  3. Pre-treatment stage as cT3-4aN0-1M0 (AJCC/UICC 7th Edition) (In case of stage cT4a, curative resectability has to be explicitly verified by the local surgical investigator prior to randomization).
  4. Age is between 18 years and 75 years,
  5. Eastern Cooperative Oncology Group (ECOG) performance status 0-1;
  6. Adequate cardiac function. All patients should perform ECG, and those with a cardiac history or ECG abnormality should perform echocardiography with the left ventricular ejection fraction > 50 %.
  7. Adequate respiratory function with FEV1≥1.2L, FEV1%≥50% and DLCO≥50% shown in pulmonary function tests.
  8. Adequate bone marrow function (White Blood Cells >4x10^9 /L; Neutrophil >2.0×10^9 /L; Hemoglobin > 90 g/L; platelets>100x10^9 /L);
  9. Adequate liver function (Total bilirubin <1.5x Upper Level of Normal (ULN); Aspartate transaminase(AST) and Alanine transaminase (ALT) <1.5x ULN);
  10. Adequate renal function (Glomerular filtration rate (CCr) >60 ml/min; serum creatinine (SCr) ≤120 µmol/L)；
  11. The patient has provided written informed consent and is able to understand and comply with the study;

Exclusion Criteria:

  1. Patients with non-squamous cell carcinoma histology;
  2. Patients with advanced inoperable or metastatic esophageal cancer;
  3. Pre-treatment stage as cT1-2N0-1M0 (AJCC/UICC 7th Edition);
  4. Pre-treatment stage as cN2-3 or cT4b(non-curatively-resectable verified by the local surgical investigator, AJCC/UICC 7th Edition);
  5. Patients with another previous or current malignant disease which is likely to interfere with treatment or the assessment of response in the judgement of the local surgical investigator.
  6. Any patient with a significant medical condition which is thought unlikely to tolerate the therapies. Such as cardiac disease (e.g. symptomatic coronary artery disease or myocardial infarction within last 12 months), clinically-significant lung disease, clinically-significant bone marrow, liver, renal function disorder;
  7. Pregnant or lactating women and fertile women who will not be using contraception during the trial;
  8. Allergy to any drugs;
  9. Participation in another intervention clinical trial with interference to the chemotherapeutic or chemoradiotherapeutic intervention during this study or during the last 30 days prior to informed consent;
  10. Expected lack of compliance with the protocol.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: Neoadjuvant chemoradiotherapy
Neoadjuvant chemoradiotherapy (NCRT) is performed followed by minimally invasive esophagectomy in enrolled patients.
Procedure: Neoadjuvant Chemoradiotherapy
Before surgery, patients in this group receive neoadjuvant chemoradiotherapy. A total dose of 40 Gy is delivered in 20 fractions (5 fractions per week) for 4 weeks. Chemotherapy is delivered concomitantly and composed of four cycles of paclitaxel 50mg per square meter of body-surface area and cisplatin 25mg per square meter of body-surface area weekly at the intervals of radiotherapy. After neoadjuvant therapy of 4-8 weeks, minimally invasive esophagectomy is performed.
Other Names:
  • Preoperative Chemoradiotherapy
Procedure: Minimally Invasive Esophagectomy
After neoadjuvant therapy, patients in groups receive minimally invasive esophagectomy
Other Names:
  • MIE
ACTIVE_COMPARATOR: Neoadjuvant chemotherapy
Neoadjuvant chemotherapy (NCT) is performed followed by minimally invasive esophagectomy in enrolled patients.
Procedure: Minimally Invasive Esophagectomy
After neoadjuvant therapy, patients in groups receive minimally invasive esophagectomy
Other Names:
  • MIE
Procedure: Neoadjuvant Chemotherapy
Before surgery, patients in this group receive neoadjuvant chemotherapy. Chemotherapy is delivered and composed of two cycles of paclitaxel 135mg per square meter of body-surface area and cisplatin 75mg per square meter of body-surface area every 4 weeks. After neoadjuvant therapy of 4-8 weeks, minimally invasive esophagectomy is performed.
Other Names:
  • Preoperative Chemotherapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Overall survival(OS)
Time Frame: Up to the date of death of any causes since the date of randomization, up to 36 months
Up to the date of death of any causes since the date of randomization, up to 36 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
R0 resection rate
Time Frame: Up to the date of pathological reports obtained since the date of randomization, up to 12 months
No vital tumor is presented at the proximal, distal, or circumferential resection margin, it is considered to be R0 resection. If a vital tumor is shown at 1 mm or less from the proximal, distal, or circumferential resection margin, it is considered to be microscopically positive (R1).
Up to the date of pathological reports obtained since the date of randomization, up to 12 months
Recurrence-free survival (RFS)
Time Frame: Up to the date of disease recurrence since the date of surgery, up to 36 months
RFS is defined in resected patients who achieved an R0 or R1 resection as the time interval from surgery to the date of first recurrence (local, regional or distant) or death, whichever comes first.
Up to the date of disease recurrence since the date of surgery, up to 36 months
Progression-free survival(PFS)
Time Frame: Up to the date of disease recurrence since the date of randomization, up to 36 months
Disease recurrence is defined as locoregional (esophageal bed or anastomotic or regional lymph nodes) or metastatic (supraclavicular lymph nodes or distant organs).
Up to the date of disease recurrence since the date of randomization, up to 36 months
Pathological response rate(pCR)
Time Frame: Up to the date of pathological reports obtained since the date of randomization, up to 12 months
The resected specimen following neo-adjuvant treatment are assessed by using standardised work up of the resection specimen in the pathology department and standardised histological criteria for tumour regression grading. The degree of histomorphologic regression is clarified into four categories as follows: grade 1, no evidence of vital residual tumor cells (pathological complete response); grade 2, less than 10% vital residual tumor cells; grade 3, 10 to 50%; and grade 4, more than 50%.
Up to the date of pathological reports obtained since the date of randomization, up to 12 months
Positive lymph nodes' number
Time Frame: Up to the date of pathological reports obtained since the date of randomization, up to 12 months
According to pathological reports, record the number of positive lymph nodes
Up to the date of pathological reports obtained since the date of randomization, up to 12 months
Treatment related complications
Time Frame: Up to 1 month after surgery since the data of randomization, up to 13 months
Number and severity of adverse events that are related to treatment of each patients, and hospital readmission.
Up to 1 month after surgery since the data of randomization, up to 13 months
Quality of life(QOL)
Time Frame: Up to the end of follow-up since the data of surgery, up to 36 months
QOL is respectively evaluated at randomization and 1 month, 3 month, 6 month and yearly after surgery among patients by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ-C30) and EORTC QLQ-OES18
Up to the end of follow-up since the data of surgery, up to 36 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Shanghai Zhongshan Hospital

Collaborators

Ruijin Hospital
Tianjin Medical University Cancer Institute and Hospital
Shanghai Chest Hospital
Wuhan Union Hospital, China
Fujian Medical University Union Hospital
First Affiliated Hospital of Wenzhou Medical University
Changzhi Medical College
First Affiliated Hospital of Chongqing Medical University
Peking University Cancer Hospital and Institute

Investigators

  • Study Director: Lijie Tan, MD, Shanghai Zhongshan Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

January 1, 2017

Primary Completion (ACTUAL)

February 1, 2019

Study Completion (ACTUAL)

August 1, 2020

Study Registration Dates

First Submitted

December 17, 2016

First Submitted That Met QC Criteria

December 22, 2016

First Posted (ESTIMATE)

December 23, 2016

Study Record Updates

Last Update Posted (ACTUAL)

September 10, 2020

Last Update Submitted That Met QC Criteria

September 7, 2020

Last Verified

September 1, 2020

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CMISG1701

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

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.

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