- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04103372
Pre-therapeutic MRI Assessment of Early Stage Rectal Cancer and Significant Rectal Polyps to Avoid Major Resectional Surgery: A New Approach to the Management of Early Stage Rectal Cancer. (PRESERVE)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The national bowel cancer screening programme (BCSP) has shown an increase in detection rates of early rectal cancer (ERC). This is treated effectively with radical surgery, offering excellent oncological outcome, but has a major impact on patient quality of life. The diagnosis of early stage rectal cancer, allows an opportunity for effective oncological treatment, with preservation of the rectum avoiding the deleterious effects of unselective use of radical surgery and unselected use of radiotherapy. Our previous work has led to High-Spatial-Resolution magnetic resonance imaging (MRI) as the established modality for providing reliable information about extramural disease prior to radical surgery.
This trial will use a new MRI staging protocol to identify more patients with early rectal cancer to enable accurate mapping for more precise patient selection for local excision. Improved success with local excision will result in greater rates of organ preservation.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Gina Brown
- Phone Number: +442086613964
- Email: gina.brown@rmh.nhs.uk
Study Contact Backup
- Name: Xian van Gelder
- Phone Number: 4344 +442086426011
- Email: xian.vangelder@rmh.nhs.uk
Study Locations
-
-
London
-
Chelsea, London, United Kingdom, SW3 6JJ
- The Royal Marsden NHSHFT
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Principal Investigator:
- Gina Brown
-
Contact:
- Gina Brown
- Phone Number: +442086613964
- Email: gina.brown@rmh.nhs.uk
-
Contact:
- Xian van Gelder
- Phone Number: 4344 +442086426011
- Email: xian.vangelder@rmh.nhs.uk
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- mrT3b tumour or less on initial assessment
- Absence of mrEMVI / mrN1c deposits
- mrCRM clear >1mm
- Rectal lesion as defined on MRI/Endoscopy. (If patients are registered at endoscopy and later found, on MRI, not to have a rectal ERC, they should be withdrawn from the study)
- Over 18 years of age
- Of adequate performance status to be able to undergo surgery if necessary
Exclusion Criteria:
- are requiring neoadjuvant therapy for MRI-staged advanced rectal cancer
- have metastatic disease
- have a second malignancy where there is <95% certainty of survival from the treated disease
- are unable to consent or withhold consent
- have biopsy-proven malignancy which is not adenocarcinoma (Patients do not need to have had a biopsy prior to registration. However, if after excision the ERC is found to either not be an adenocarcinoma or be benign, the patient should be withdrawn from the study.)
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 |
---|---|
Active Comparator: Low risk
MR Staged >1mm muscularis preserved and technically feasible to perform local excision.
Pathology assessment on sample with confirmation of adenocarcinoma.
Sample assessed to be low risk based on PRESERVE Risk Score of 0. (Margin Clear >0mm from the diathermy margin and Sm1/2 or Haggitt 1/2/3) Six monthly follow up from date of surgery.
|
6 monthly surveillance
|
Active Comparator: Moderate Risk - RT&Surveillance
MR Staged >1mm muscularis preserved and technically feasible to perform local excision.
Pathology assessment on sample with confirmation of adenocarcinoma.
Sample assessed to be low risk based on PRESERVE Risk Score of 1. (Margin positive -0mm to the diathermy margin, or SM3 or Haggitt 4, or LVI) Patient randomized to receive radiotherapy (RT) and regular surveillance, with 3 monthly follow-up from the date of surgery.
|
as per local policy
|
Active Comparator: Moderate Risk - Surveillance
MR Staged >1mm muscularis preserved and technically feasible to perform local excision.
Pathology assessment on sample with confirmation of adenocarcinoma.
Sample assessed to be low risk based on PRESERVE Risk Score of 1. (Margin positive -0mm to the diathermy margin, or SM3 or Haggitt 4, or LVI) Patient randomized to surveillance arm with regular surveillance, with 3 monthly follow-up from the date of surgery.
|
3 monthly surveillance
|
Active Comparator: High Risk
MR Staged >1mm muscularis preserved and technically feasible to perform local excision.
Pathology assessment on sample with confirmation of adenocarcinoma.
Sample assessed to be low risk based on PRESERVE Risk Score of >2.
(Margin positive - 0mm to the diathermy margin, Margin positive/or unassessable due to piecemeal removal - 0mm to the tumour margin, Sm3 or Haggitt 4, Poorly differentiated/mucinous, LVI, T2) Patient is considered for surgery, receives radiotherapy and surveillance, with 3 monthly follow-up from date of surgery.
|
as per local policy
|
Active Comparator: TME (Total mesorectal excision) Surgery
For patients where it is considered technically feasible to do LE but MR staged<1mm muscularis preserved, or it is considered not feasible to perform a local excision.
Patients undergo TME surgery.
Pathology assessment on sample with confirmation of adenocarcinoma.
Patient receives 6 monthly follow-up from date of surgery.
|
6 monthly surveillance
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Demonstrate a change in rectal preservation rates
Time Frame: 36 months
|
Demonstrate a change in rectal preservation rates in patients with pT1 and pT2 tumours.
|
36 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
To measure the accuracy of MRI T staging when compared with pathology.
Time Frame: 36 months
|
To measure the accuracy of MRI T staging when compared with pathology.
|
36 months
|
Rates of missed lesions for local excision
Time Frame: 36 months
|
Report on rates of missed lesions suitable for local excision.
|
36 months
|
Rates of lesions not for local excision
Time Frame: 36 months
|
Report on rates of lesions not feasible for local excision
|
36 months
|
Cost comparison
Time Frame: 36 months
|
Compare costs to the NHS/other healthcare systems of major surgery versus local excision for pT1/T2 ERC.
|
36 months
|
Measure impact on patient quality of life
Time Frame: 36 months
|
Measure impacts of local excision and rectal preservation on patient reported quality of life outcome measures compared with stage matched patients undergoing major surgery due to patient choice or technical inability to undertake locale scission.
Measurement tools used for assessment are the LARS (low anterior resection syndrome) score, the EQ-5D and Stoma Care Quality of Life Questionnaire.
|
36 months
|
Measure relapse-free rates at 1 year post surgery / local excision.
Time Frame: 36 months
|
Put in a separate point saying: Measure survival rates at 1 year post surgery / local excision.
|
36 months
|
Assess the quality of local excision surgery
Time Frame: 36 months
|
To assess the quality of local excision surgery, using review of pathology slides and reports, commenting on completeness of excision, excision margins and en bloc manner of resection (local excision specimens).
|
36 months
|
Assess patient willingness to be randomised
Time Frame: 36 months
|
Assess patient willingness to be randomised by qualitative questionnaire
|
36 months
|
Collaborators and Investigators
Collaborators
Study record dates
Study Major Dates
Study Start (Anticipated)
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
Other Study ID Numbers
- CCR 4993
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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