- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03188562
Comparison of Diagnostic and Therapeutic Efficacy of EBUS-TBNA/EUS-FNA and TEMLA in Operable NSCLC.
Comparison of Diagnostic and Therapeutic Efficacy of Endobronchial/Endoesophageal Ultrasound and Transcervical Extended Mediastinal Lymphadenectomy in Non-Small-Cell Lung Cancer. A Randomised Controlled Trial
The aim of the study is prospective comparison of diagnostical and therapeutical efficiency between different methods of mediastinal lymph node preoperative staging in Non-Small-Cell Lung Cancer (NSCLC).
Two hundred patients with histologically/cytologically confirmed clinical stage primary I-IIIA NSCLC will be included. The patients must be fit enough to undergo at least pulmonary lobectomy. Computer Tomography (CT) and Positron Emission Tomography (PET/CT) will be performed in all patients. Subsequently, the patients without evidence of dissemination will be randomized to transbronchial and transesophageal endoscopic ultrasound-guided needle aspiration ( EBUS-TBNA, EUS-NA) or Transcervical Extended Mediastinal Lymphadenectomy (TEMLA). The patients with N3 will be referred to definitive oncological treatment, the patients with N2 metastases will be referred to neoadjuvant treatment and the patients without N2/3 metastases will be operated on. The operative procedure will include at least lobectomy with complete lymphadenectomy, with open or video-assisted (VATS) technique. The patients undergoing sublobar resection will be excluded from this study. Final analysis will include comparison of the diagnostic yield and 5-year survival between the EBUS/EUS and the TEMLA arms.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Non-Small-Cell Lung Cancer (NSCLC) is the most common malicious neoplasm characterized by very bad prognosis: 5-year survival rate is only 15%, and the main factors responsible for unfavorable treatment results are late diagnosis, rapid progression of the tumor and high rate of metastasis. The most important issue before selection of the treatment is to establish presence of the metastasis to nodes on the same side of the body (N2) and to lymph nodes on the other side of the mediastinum or a spread to the supraclavicular nodes (N3).
A presence of metastasis to N2 (stage IIIA) is not an absolute contradiction for the surgical treatment but a discovery of N2 is followed by referral of the patients for neoadjuvant or adjuvant treatment depending if N2 are found before or after surgery. Presence of N3 is a contraindication for surgery and an indication for chemo-radiotherapy.
Preoperative techniques of lymph nodes staging includes CT, PET/CT and endoscopy/ultrasound techniques EBUS-TBNA and EUS-NA. Surgical staging techniques include mediastinoscopy, anterior mediastinotomy, VATS, Video-mediastinoscopic lymphadenectomy (VAMLA) and TEMLA.
Endobronchial Ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) and Endoscopic Ultrasound guided Needle Aspiration (EUS-NA) are real-time imagining and biopsy techniques used in lung cancer staging. Transbronchial ultrasound examination allow to access upper and lower right paratracheal nodes (2R, 4R), subcarinal (7), hilar and interlobar (10, 11), transesophageal ultrasound examination allow to visualize upper and lower left paratracheal nodes (2L, 4L), subaortic (5), para-aortic (6), subcarinal (7), paraesophageal (8), pulmonary ligament (9) nodes. Furthermore EUS allow to localize mediastinal structures including heart, big vessels, main bronchi, vertebral column and diaphragm and can be used in for visualization of tumor infiltration of surrounding structures especially aorta, pulmonary artery or left atrium.
Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) is minimally invasive surgical technique enabling extensive bilateral lymphadenectomy. The procedure starts from 5-8 cm collar incision in the neck, sternum is elevated with a hook connected to a Rochard frame, both laryngeal recurrent nerves and vagus nerves are visualized. During TEMLA all mediastinal nodal stations except for the pulmonary ligament nodes (9) are removed.
There are many controversions what is the optimal preoperative staging in patients with NSCLC.
It this prospective randomized study we plan to compare preoperative staging with EBUS/EUS with TEMLA in 200 patients.
The patients with histologically or cytologically proven clinical stage I-IIIA NSCLC will be included.
The other inclusion criteria are no previous cancer treatment history, no medical contraindication to operation with at least pulmonary lobectomy, adequate cardiac and pulmonary function.
All patients will undergo CT and PET/CT. The patients without dissemination of cancer will be randomized into the EBUS/EUS and the TEMLA arms. All patients with mediastinal metastasis discovered during staging will be referred to oncological treatment. Patients without mediastinal involvement will be treated with radical surgical treatment (lobectomy or pneumonectomy with lymphadenectomy) with open or video-assisted (VATS) technique. The patients undergoing sublobar resection will be excluded from this study.
Final analysis will include comparison of the diagnostic yield and 5-year survival between the EBUS/EUS and the TEMLA arms. The study is intended to clarify the issue of the optimal preoperative staging and the possible impact of extended bilateral mediastinal lymphadenectomy on the survival of NSCLC.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Zakopane, Poland, 34-500
- Pulmonary Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- patients with histologically or cytologically proven clinical stage I-IIIA NSCLC
- no medical contraindication to operation with at least pulmonary lobectomy
- adequate cardiac and pulmonary function
Exclusion Criteria:
- previous cancer treatment history
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: EBUS-TBNA, EUS-NA
|
Positron Emission Tomography (PET/CT)
Transbronchial and Transesophageal endoscopic ultrasound-guided needle aspiration ( EBUS-TBNA, EUS-NA) Transbronchial ultrasound examination allow to access upper and lower right paratracheal nodes (2R, 4R), subcarinal (7), hilar and interlobar (10, 11), transesophageal ultrasound examination allow to visualize upper and lower left paratracheal nodes (2L, 4L), subaortic (5), para-aortic (6), subcarinal (7), paraesophageal (8), pulmonary ligament (9) nodes.
Furthermore EUS allow to localize mediastinal structures including heart, big vessels, main bronchi, vertebral column and diaphragm and can be used in for visualization of tumor infiltration of surrounding structures especially aorta, pulmonary artery or left atrium.
|
Experimental: TEMLA
|
Positron Emission Tomography (PET/CT)
Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) is minimally invasive surgical technique enabling extensive bilateral lymphadenectomy.
The procedure starts from 5-8 cm collar incision in the neck, sternum is elevated with a hook connected to a Rochard frame, both laryngeal recurrent nerves and vagus nerves are visualized.
During TEMLA all mediastinal nodal stations except for the pulmonary ligament nodes (9) are removed.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
comparison of the diagnostic yield of EBUS/EUS and TEMLA
Time Frame: 2 weeks after the end of surgery
|
after radical surgical treatment (lobectomy or pneumonectomy with lymphadenectomy)
|
2 weeks after the end of surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
5-year survival between the EBUS/EUS and the TEMLA arms
Time Frame: 5-year
|
individual or phone contact with each patient
|
5-year
|
Collaborators and Investigators
Sponsor
Investigators
- Study Director: Marcin Zielinski, PhD, Pulmonary Hospital, Zakopane, Poland
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 02/2014
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.
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