- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03222635
Prospective Endoscopic Follow-up of Patients With Submucosal Esophageal Adenocarcinoma (The PREFER Trial)
Endoscopic Management of Patients With T1bN0M0 Esophageal Adenocarcinoma: a Prospective Multicenter Registry.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Traditionally, the risk of lymph node metastasis associated with submucosal EAC was considered too high to offer patients endoscopic follow-up. Only in elderly patients with comorbidity, more often an endoscopic protocol is selected. However, the risk of lymph node metastasis associated with submucosal EAC is mainly based on surgical series. Recently a number of studies, which included patients treated endoscopically, were published indicating that the risk of lymph node metastasis may be much lower than generally assumed.Therefore, a less invasive and organ preserving approach may not only be an option in the frail and elderly, but for all patients with submucosal EAC's.
Yet, no data exists on the risk of lymph node metastasis in high risk T1a EAC. The risk is assumed to be lower than for EACs invading into the submucosal layer. However, a recent (unpublished) retrospective analysis from our own research group shows that this risk may be higher than previously assumed. In this nationwide retrospective study, we analysed lymph node metastasis rates and EAC related mortality rates concerning patients with high risk T1a, low risk T1b or high risk T1b EAC who received endoscopic treatment. The study was performed in 9 Barrett Expert Centers in the Netherlands (2008-2019). 120 patients were included in the analysis, and results showed the highest lymph node metastasis risk in the high risk T1a patient group Aim of this multicenter study is to prospectively evaluate the safety of endoscopic follow-up in patients treated by endoscopic resection for submucosal (T1bN0M0) EAC.
High-resolution upper endoscopy with white-light endoscopy and narrow-band imaging supplemented with an EUS are performed every three months during the first two years after ER. After 1 year, a CT-thorax/abdomen will be performed to check for distant metastasis. During the third and fourth year of follow-up, EUS and upper endoscopy are performed every six months. From the fifth year on, EUS and upper endoscopy are performed annually.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Esther Nieuwenhuis, MD
- Phone Number: +31645916097
- Email: e.a.nieuwenhuis@amsterdamumc.nl
Study Contact Backup
- Name: W. D. Rosmolen, Master
- Phone Number: +31205663252
- Email: w.d.rosmolen@amsterdamumc.nl
Study Locations
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Sydney, Australia
- Recruiting
- Westmead Hospital
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Contact:
- M. Bourke, MD, PhD
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Leuven, Belgium
- Recruiting
- Uz Gasthuisberg
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Contact:
- R. Bisschops, MD, PhD
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Principal Investigator:
- R. Bisschops, MD, PhD
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Nantes, France
- Recruiting
- CHU Nantes
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Contact:
- Emmanuel Coron
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Augsburg, Germany
- Not yet recruiting
- Universitatsklinikum Augsburg
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Contact:
- H. Messmann
- Email: Helmut.Messmann@uk-augsburg.de
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Duesseldorf, Germany
- Recruiting
- EVK Duesseldorf
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Contact:
- Horst Neuhaus
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Münich, Germany
- Recruiting
- MRI TUM
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Contact:
- Christoph Schlag
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Regensburg, Germany
- Recruiting
- Barmherzige Brüder Regensburg
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Contact:
- Oliver Pech
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Amsterdam, Netherlands
- Recruiting
- Academic Medical Center
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Contact:
- W. D. Rosmolen, Master
- Phone Number: +31205663252
- Email: w.d.rosmolen@amsterdamumc.nl
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Contact:
- E. Nieuwenhuis, MD
- Phone Number: +31205661613
- Email: e.a.nieuwenhuis@amsterdamumc.nl
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Principal Investigator:
- J. J. Bergman, MD, PhD
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Principal Investigator:
- R. E. Pouw, MD, PhD
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Amsterdam, Netherlands
- Recruiting
- VUMC
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Contact:
- E. Nieuwenhuis, MD
- Phone Number: +31645916097
- Email: e.a.nieuwenhuis@amsterdamumc.nl
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Eindhoven, Netherlands
- Recruiting
- Catharina hospital
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Contact:
- E. J. Schoon, MD, PhD
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Principal Investigator:
- E. J. Schoon, MD, PhD
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Groningen, Netherlands
- Recruiting
- University Medical Center Groningen
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Contact:
- W. B. Nagengast, MD, PhD
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Principal Investigator:
- W. B. Nagengast, MD, PhD
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Nieuwegein, Netherlands
- Recruiting
- St. Antonius Hospital
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Contact:
- B. L. Weusten, MD, PhD
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Principal Investigator:
- B. L. Weusten, MD, PhD
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Nijmegen, Netherlands
- Recruiting
- Radboudumc
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Contact:
- P. Siersema, MD, PhD
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Rotterdam, Netherlands
- Recruiting
- Erasmus MC - University Medical Center
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Contact:
- A. D. Koch, MD, PhD
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Principal Investigator:
- A. D. Koch, MD, PhD
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The Hague, Netherlands
- Recruiting
- Haga Medical Center
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Contact:
- M. Houben, MD, PhD
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Principal Investigator:
- M. Houben, MD, PhD
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Zwolle, Netherlands
- Recruiting
- Isala Clinics
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Contact:
- B. E. Schenk, MD, PhD
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Principal Investigator:
- B. E. Schenk, MD, PhD
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Zürich, Switzerland
- Recruiting
- Hirslanden private hospital group
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Contact:
- S. Seewald
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London, United Kingdom
- Not yet recruiting
- University College London Hospital
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Contact:
- R. Haidry, MD, PhD
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Principal Investigator:
- R. Haidry, MD, PhD
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients with submucosal or high-risk mucosal EAC diagnosed in an ER specimen, revised by a panel of expert gastrointestinal (GI) pathologists.
- Signed informed consent.
Exclusion Criteria:
- Prior history of high-risk mucosal or ≥T1sm.
- Synchronous esophageal squamous cell carcinoma.
- Suspicion on lymph node metastasis or distant metastasis on EUS, ultrasound of the neck or CT-thorax-abdomen performed six weeks after ER during baseline measurement.
- Tumor-positive deep resection margin (R1) in ER specimen.
- Patients unable to give signed informed consent.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Endoscopic follow-up
Patients treated with endoscopic resection (ER) for a submucosal or high-risk mucosal esophageal adenocarcinoma without lymphnode- or distant metastases (T1bN0M0 EAC) will undergo endoscopic follow-up.
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Endoscopic follow-up by means of regular upper endoscopies and endoscopic ultrasounds
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
5-year disease-specific mortality/survival (descriptive statistics in SPSS, percentages, survival analysis)
Time Frame: 5 years
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Disease specific mortality is decribed as mortality directly linked to the esophageal adenocarcinoma (i.e., metastasized EAC, metastasized disease with a simultaneously primary cancer present and it cannot be ruled out (based on histology) that the metastases are related to the other primary cancer, death due to complications of the endoscopic procedure, death due to complications after surgery or CRT, no clear cause of death in patients who have metastases or untreated local recurrence).
If patients are diagnosed with distant metastases, and subsequently die of a non-tumor related cause, patients will still be documented as tumor-related death.
Will be measured in number of patients and percentages.
Survival analysis using Kaplan Meier will be performed.
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5 years
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Overall survival (descriptive statistics in SPSS, percentages, survival analysis)
Time Frame: 5 years
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Overall survival of study population (tumor-related + non-tumor-related deaths).
Measured in numbers and percentages, survival analysis (KM).
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5 years
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Lymph node metastasis, confirmed by cytology and/or histology (descriptive statistics in SPSS, number of patients (%))
Time Frame: 5 years
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Confirmed by cytology and/or histology by performing FNA during EUS or biopsies.
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5 years
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Local recurrence eligible for endoscopic therapy (descriptive statistics in SPSS, number of patients (%))
Time Frame: 5 years
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In case a local recurrence is found during FU endoscopy, histopathology have to show if it is recurrent cancer.
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5 years
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Local recurrence requiring surgical therapy (descriptive statistics in SPSS, number of patients (%))
Time Frame: 5 years
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In case a local cancer recurrence is not amendable for endoscopic re-treatment, for example due to extensive disease or fibrosis, a patient will be referred for surgery if possible.
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5 years
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Distant metastasis, histologically proven (descriptive statistics in SPSS, number of patients (%))
Time Frame: 5 years
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Primary tumor of distant metastasis should be histopathologically evalueted by taking biopsies.
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5 years
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Quality of life during follow-up endoscopies (questionnaires)
Time Frame: 5 years
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Quality of life is assessed by using questionnaires on set time points during the whole study.
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5 years
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Collaborators and Investigators
Investigators
- Principal Investigator: J. J. Bergman, MD, PhD, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
- Principal Investigator: R. E. Pouw, MD, PhD, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
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
Keywords
Additional Relevant MeSH Terms
- Digestive System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms by Site
- Carcinoma
- Neoplasms, Glandular and Epithelial
- Gastrointestinal Neoplasms
- Digestive System Neoplasms
- Gastrointestinal Diseases
- Head and Neck Neoplasms
- Esophageal Diseases
- Precancerous Conditions
- Adenocarcinoma
- Esophageal Neoplasms
- Barrett Esophagus
Other Study ID Numbers
- NL6116501817
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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